Provider Demographics
NPI:1679004592
Name:IZUCHUKWU OKPARA MD INC
Entity Type:Organization
Organization Name:IZUCHUKWU OKPARA MD INC
Other - Org Name:OMNI WOUND PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:IZUCHUKWU
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:OKPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-228-3538
Mailing Address - Street 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:661-383-7136
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:213-228-3538
Practice Address - Fax:818-356-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679004592Medicaid
CADX4098OtherMEDICARE RAILROAD
CACA245067OtherMEDICARE NORTH CALIFORNIA
CACB274157OtherMEDICARE SOUTH CALIFORNIA