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General NPI Number Information
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NPI Number | 1952618811
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Entity Type | Organization
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Legal Business Name | IRENE BIH WAKAM M.D.,A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 3555 LOMA VISTA RD STE 215
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City | VENTURA
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State | CA
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Zip | 93003-3161
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Country | US
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Telephone | 805-652-1515
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Fax | 805-652-0445
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Provider Business Mailing Address
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Address Line | 3555 LOMA VISTA RD STE 215
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City | VENTURA
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State | CA
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Zip | 93003-3161
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Country | US
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Telephone | 805-652-1515
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Fax | 805-652-0445
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRENE B WAKAM
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Credential | M.D
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Telephone | 805-652-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | C50092
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License Number State | CA
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