Provider Demographics
NPI:1952618811
Name:IRENE BIH WAKAM M.D.,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IRENE BIH WAKAM M.D.,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-652-1515
Mailing Address - Street 1:3555 LOMA VISTA RD STE 215
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3161
Mailing Address - Country:US
Mailing Address - Phone:805-652-1515
Mailing Address - Fax:805-652-0445
Practice Address - Street 1:3555 LOMA VISTA RD STE 215
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-652-1515
Practice Address - Fax:805-652-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50092261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50092Medicare PIN