Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A437360 | CA |
Y | 208600000X | Surgeon | A437360 | CA |
N | 2086S0127X | Trauma Surgeon | A437360 | CA |
N | 2086X0206X | Surgical Oncologist | A437360 | CA |
N | 208C00000X | Colorectal Surgeon | A437360 | CA |
NPI | 1427127075 |
---|---|
Provider Name | Dr. Vincent Ede Ajanwachuku |
First Address | Apple Valley, CA 92307-1377 |
Second Address | Apple Valley, CA 92307-1377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A29732 | (02) | CA |