Provider Demographics
NPI:1689707259
Name:AZINGE, MEZIA OGUGUA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEZIA
Middle Name:OGUGUA
Last Name:AZINGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEZIA
Other - Middle Name:OGUGUA
Other - Last Name:AZINGE-OKONKWO-OBASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 E HARDY ST STE 220
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4054
Mailing Address - Country:US
Mailing Address - Phone:323-290-2832
Mailing Address - Fax:323-290-2836
Practice Address - Street 1:501 E HARDY ST STE 220
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:323-290-2832
Practice Address - Fax:323-290-2836
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534492Medicaid
CA00A534490Medicaid
CA00A534491Medicaid
CA00A534492Medicaid
CAA53449Medicare ID - Type UnspecifiedSAN GABRIEL PEDIATRICS
CAG13159Medicare UPIN
CA00A534491Medicaid