Provider Demographics
NPI:1669424511
Name:MBA, EMMANUEL NWABUFO (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:NWABUFO
Last Name:MBA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:325 EAST HILLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2405
Mailing Address - Country:US
Mailing Address - Phone:310-677-7172
Mailing Address - Fax:310-677-2658
Practice Address - Street 1:325 E. HILLCREST BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2405
Practice Address - Country:US
Practice Address - Phone:310-677-7172
Practice Address - Fax:310-677-2658
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG19040207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G190400Medicaid
CA00G190400Medicaid
CAA40488Medicare UPIN
CAAM4716354OtherDEA NUMBER