Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 95019778 | CA |
NPI | 1073267746 |
---|---|
Provider Name | Ms. Ifeoma Amalachukwu Ubadike |
First Address | Clovis, CA 93619-7231 |
Second Address | Clovis, CA 93619-7231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9501778 | 207Q00000X (01) | CA |
95019778 | FAMILY MEDICINE (01) | CA |