Healthcare Provider Details

I. General information

NPI: 1821937780
Provider Name (Legal Business Name): CHUKWUMA IKENZE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 W MAIN ST
MERCED CA
95340-4715
US

IV. Provider business mailing address

547 W MAIN ST
MERCED CA
95340-4715
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-1205
  • Fax: 209-318-1380
Mailing address:
  • Phone: 209-384-1205
  • Fax: 209-318-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: