Provider Demographics
NPI:1801815949
Name:EJIKE ONYEADOR OFFICE
Entity Type:Organization
Organization Name:EJIKE ONYEADOR OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ MEDICAL ASST.
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-223-0684
Mailing Address - Street 1:555 W COMPTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3037
Mailing Address - Country:US
Mailing Address - Phone:310-223-0684
Mailing Address - Fax:310-223-0687
Practice Address - Street 1:555 W COMPTON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3037
Practice Address - Country:US
Practice Address - Phone:310-223-0684
Practice Address - Fax:310-223-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45589261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care