Healthcare Provider Details

I. General information

NPI: 1679405583
Provider Name (Legal Business Name): AZUBUIKE FAMILY MEDICINE CLINIC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N EUCLID AVE STE B
UPLAND CA
91786-8323
US

IV. Provider business mailing address

300 N EUCLID AVE STE B
UPLAND CA
91786-8323
US

V. Phone/Fax

Practice location:
  • Phone: 909-217-5427
  • Fax: 213-410-5188
Mailing address:
  • Phone: 909-217-5427
  • Fax: 213-410-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AKACHI C AZUBUIKE
Title or Position: PRESIDENT
Credential: MD
Phone: 909-217-5427