Provider Demographics
NPI:1912338963
Name:AFFORDABLE CARE411 NETWORK INC.
Entity Type:Organization
Organization Name:AFFORDABLE CARE411 NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:IZUCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FACP
Authorized Official - Phone:424-333-1863
Mailing Address - Street 1:PO BOX 13042
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-4042
Mailing Address - Country:US
Mailing Address - Phone:562-423-8000
Mailing Address - Fax:310-362-0390
Practice Address - Street 1:911 E SAN ANTONIO DR
Practice Address - Street 2:STE 3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:562-423-8000
Practice Address - Fax:310-362-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC02783Medicare UPIN