Provider Demographics
NPI:1497947782
Name:CHUKWUEMEKA NDULUE
Entity type:Organization
Organization Name:CHUKWUEMEKA NDULUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-868-7292
Mailing Address - Street 1:620 E ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5503
Mailing Address - Country:US
Mailing Address - Phone:530-741-2600
Mailing Address - Fax:530-741-2659
Practice Address - Street 1:620 E ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5503
Practice Address - Country:US
Practice Address - Phone:530-741-2600
Practice Address - Fax:530-741-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
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
CARHM53928FMedicaid
CA553928Medicare PIN