Healthcare Provider Details

I. General information

NPI: 1366534901
Provider Name (Legal Business Name): CHARLES ENYIDULU UGWU-OJU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S A ST
MADERA CA
93638-3619
US

IV. Provider business mailing address

840 E ALMOND AVE
MADERA CA
93637-5603
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-674-2234
  • Fax: 559-674-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA501870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: