Healthcare Provider Details

I. General information

NPI: 1205901154
Provider Name (Legal Business Name): ANGELA IJEOMA UBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 E DELAWARE LN
VANCOUVER WA
98664
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-5128
  • Fax: 360-896-5179
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFU0058330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: