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NPI Code Detail

MEDICARE: BONIFACE O ONUBAH, M.D. INC.

MEDICARE: BONIFACE O ONUBAH, M.D. INC.
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
1207R00000XInternal Medicine PhysicianA52415CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A52415OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1619168150
Entity Type Code : Organization
Provider Name (Legal Business Name) : BONIFACE O ONUBAH, M.D. INC.
Provider Business Mailing Address
First Line : 2501 W BURBANK BLVD
Second Line : 308
City : BURBANK
State : CA
Zip : 91505-2347
Country : US
Telephone Number : 310-207-5100
Fax Number : 818-557-6491
Provider Business Practice Location Address
First Line : 2501 W BURBANK BLVD
Second Line : 308
City : BURBANK
State : CA
Zip : 91505-2347
Country : US
Telephone Number : 310-207-5100
Fax Number : 818-557-6491
Authorized Official
Title or Position : CEO/M.D.
Name : DR. BONIFACE O ONUBAH
Credential : M.D.
Telephone Number : 310-702-5100
Provider Enumeration Date : 08/08/2007
Last Update Date : 08/08/2007

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