Provider Demographics
NPI:1336524412
Name:UGOCHUKWU, IFEOMA L (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEOMA
Middle Name:L
Last Name:UGOCHUKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23890 COPPER HILL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1701
Mailing Address - Country:US
Mailing Address - Phone:818-613-7158
Mailing Address - Fax:
Practice Address - Street 1:23890 COPPER HILL DR STE 160
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1701
Practice Address - Country:US
Practice Address - Phone:818-613-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine