=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568924660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHUKWUDI CHARLES MUOJIEJE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2019
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4502 N SONOMA RANCH BLVD
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-800-3636
-----------------------------------------------------
Fax | 575-288-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4502 N SONOMA RANCH BLVD
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-800-3636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD20240787
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------