Basic Information
| Provider Information | |||||||||
| NPI: | 1811992738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IZUCHUKWU | ||||||||
| FirstName: | IFEOMA | ||||||||
| MiddleName: | STELLA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D, MPH, FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13042 | ||||||||
| Address2: | |||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902954042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886641121 | ||||||||
| FaxNumber: | 3103620390 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 WOODYARD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405463428 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A80750 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0095079 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.