MEDICARE: UJU PRECIOUS EZEAMAMA MD, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A163353	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	A163353	CA

General Provider Information

NPI Number	:	1316462724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UJU PRECIOUS EZEAMAMA MD, MSN

Provider Business Mailing Address
First Line	:	1518 N PEACH AVE APT 214A
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-1532
Country	:	US
Telephone Number	:	909-713-6876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2300
Country	:	US
Telephone Number	:	951-781-2200
Fax Number	:	951-781-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	01/24/2024

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