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General NPI Number Information
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NPI Number | 1154942308
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Entity Type | Organization
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Legal Business Name | IFEACHO MEDICAL CORP
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 388 MARKET ST STE 1300
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-5316
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Country | US
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Telephone | 951-660-4644
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Fax |
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Provider Business Mailing Address
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Address Line | 201 13TH ST # 1263
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City | OAKLAND
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State | CA
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Zip | 94612-3921
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Country | US
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Telephone | 951-660-4464
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VALENTINE IFEACHO
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Credential | M.D.
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Telephone | 951-660-4464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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