Provider Demographics
NPI:1922397876
Name:IWUAJOKU, JOSEPH (PA)
Entity Type:Individual
Prefix:PROF
First Name:JOSEPH
Middle Name:
Last Name:IWUAJOKU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3221
Mailing Address - Country:US
Mailing Address - Phone:805-983-0547
Mailing Address - Fax:805-983-0423
Practice Address - Street 1:2403 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3221
Practice Address - Country:US
Practice Address - Phone:805-983-0547
Practice Address - Fax:805-983-0423
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13503OtherPHYSICIANS ASSISTANT LICENCE