Healthcare Provider Details

I. General information

NPI: 1568924660
Provider Name (Legal Business Name): CHUKWUDI CHARLES MUOJIEJE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-8262
US

IV. Provider business mailing address

4502 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-8262
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-3636
  • Fax: 575-288-1861
Mailing address:
  • Phone: 575-800-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD20240787
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: