Healthcare Provider Details

I. General information

NPI: 1154366987
Provider Name (Legal Business Name): EMEKA BERNARD OKWUJE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CAMINO DEL RIO N SUITE 355
SAN DIEGO CA
92108-1621
US

IV. Provider business mailing address

2650 CAMINO DEL RIO N SUITE 355
SAN DIEGO CA
92108-1621
US

V. Phone/Fax

Practice location:
  • Phone: 619-851-6997
  • Fax: 619-347-2427
Mailing address:
  • Phone: 619-851-6997
  • Fax: 619-374-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA81449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: