Provider Demographics
NPI:1891870069
Name:CHUKWUEMEKA NDULUE
Entity Type:Organization
Organization Name:CHUKWUEMEKA NDULUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHUK
Authorized Official - Middle Name:
Authorized Official - Last Name:NDULUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-846-1400
Mailing Address - Street 1:135 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2239
Mailing Address - Country:US
Mailing Address - Phone:530-846-1400
Mailing Address - Fax:530-846-4762
Practice Address - Street 1:135 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2239
Practice Address - Country:US
Practice Address - Phone:530-846-1400
Practice Address - Fax:530-846-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53931FMedicaid
CARHM53931FMedicaid
CA553931Medicare PIN