Provider Demographics
NPI:1316917065
Name:AMUZIE, IFEANYI (MD)
Entity type:Individual
Prefix:MR
First Name:IFEANYI
Middle Name:
Last Name:AMUZIE
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 1:2230 LYNN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-371-0647
Mailing Address - Fax:805-371-0649
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-371-0647
Practice Address - Fax:805-371-0649
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G277731Medicaid
CA00G277731Medicaid
CAG027773Medicare ID - Type Unspecified