MEDICARE: NDUBUISI O CHIJIOKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	17348	CA

General Provider Information

NPI Number	:	1043245616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NDUBUISI O CHIJIOKE

Provider Business Mailing Address
First Line	:	16225 DEVONSHIRE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6910
Country	:	US
Telephone Number	:	818-832-1920
Fax Number	:	818-832-1921

Provider Business Practice Location Address
First Line	:	16225 DEVONSHIRE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6910
Country	:	US
Telephone Number	:	818-832-1920
Fax Number	:	818-832-1921

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NDUBUISI OGBONNAYA CHIJIOKE
Credential	:
Telephone Number	:	818-832-1920

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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