MEDICARE: NNEAMAKA AJALLA PRIEST MD

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	208000000X	Pediatrics Physician	29242	OK
2	208000000X	Pediatrics Physician	A151054	CA

General Provider Information

NPI Number	:	1831450519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNEAMAKA AJALLA PRIEST MD

Provider Business Mailing Address
First Line	:	321 N LARCHMONT BLVD STE 1020
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6410
Country	:	US
Telephone Number	:	323-960-8500
Fax Number	:	323-960-8585

Provider Business Practice Location Address
First Line	:	321 N LARCHMONT BLVD STE 1020
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6410
Country	:	US
Telephone Number	:	323-960-8500
Fax Number	:	323-960-8585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	01/22/2019

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