MEDICARE: IJEOMA UCHE M.D, PHARMD

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	207R00000X	Internal Medicine Physician	A152328	CA

General Provider Information

NPI Number	:	1851686638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IJEOMA UCHE M.D, PHARMD

Provider Business Mailing Address
First Line	:	26224 N TATUM BLVD STE 5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-882-7582
Fax Number	:	480-563-7442

Provider Business Practice Location Address
First Line	:	22635 ALESSANDRO BLVD
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8550
Country	:	US
Telephone Number	:	951-242-2226
Fax Number	:	951-242-8969

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/27/2024

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