Provider Demographics
NPI:1063423903
Name:OHIAERI, IKECHUKWU ANELE (MD)
Entity type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:ANELE
Last Name:OHIAERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14344 CAJON ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4301
Mailing Address - Country:US
Mailing Address - Phone:760-843-0506
Mailing Address - Fax:
Practice Address - Street 1:14344 CAJON ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4301
Practice Address - Country:US
Practice Address - Phone:760-843-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA518352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A518353Medicaid
CAF91389Medicare UPIN