Provider Demographics
NPI:1245506989
Name:AJEMBA, OGUGUA GERALDINE (MD)
Entity type:Individual
Prefix:DR
First Name:OGUGUA
Middle Name:GERALDINE
Last Name:AJEMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:OGUGUA
Other - Middle Name:GERALDINE
Other - Last Name:ONYEKWELU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17626 WREN DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3826
Mailing Address - Country:US
Mailing Address - Phone:914-217-5756
Mailing Address - Fax:
Practice Address - Street 1:15248 ELEVENTH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3704
Practice Address - Country:US
Practice Address - Phone:914-217-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135148207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology