Healthcare Provider Details

I. General information

NPI: 1487596920
Provider Name (Legal Business Name): IVA UJAMAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

1102 E KAY ST
COMPTON CA
90221-1517
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2568
  • Fax:
Mailing address:
  • Phone: 310-613-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: