=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447320817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAXWELL OHIKHUARE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26520 CACTUS AVE
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-486-4015
-----------------------------------------------------
Fax | 951-486-4545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26520 CACTUS AVE
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-486-4015
-----------------------------------------------------
Fax | 951-486-4545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G39164
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------