Provider Demographics
NPI:1639448269
Name:IKEDIOBI, OGECHI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:OGECHI
Middle Name:
Last Name:IKEDIOBI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 UNIVERSITY CENTER LN STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1010
Mailing Address - Country:US
Mailing Address - Phone:858-657-8322
Mailing Address - Fax:
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1010
Practice Address - Country:US
Practice Address - Phone:858-657-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62300183500000X
CA390200000X
CAA165972207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program