Healthcare Provider Details

I. General information

NPI: 1710035126
Provider Name (Legal Business Name): THECLA N. MGBOJIRIKWE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THECLA N IKEDUM M.D.

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 N WILMINGTON BLVD
WILMINGTON CA
90744-4102
US

IV. Provider business mailing address

936 N WILMINGTON BLVD
WILMINGTON CA
90744-4102
US

V. Phone/Fax

Practice location:
  • Phone: 310-816-3111
  • Fax: 310-816-3116
Mailing address:
  • Phone: 310-816-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA83572
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: