Healthcare Provider Details

I. General information

NPI: 1386021509
Provider Name (Legal Business Name): EMMANUEL OBIAJULU UNACHUKWU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E FOOTHILL BLVD
RIALTO CA
92376-5153
US

IV. Provider business mailing address

425 E FOOTHILL BLVD
RIALTO CA
92376-5153
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-1050
  • Fax: 909-546-1061
Mailing address:
  • Phone: 909-546-1050
  • Fax: 909-546-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA150606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: