Provider Demographics
NPI:1386304426
Name:EKANEM, UWEM IME
Entity type:Individual
Prefix:
First Name:UWEM
Middle Name:IME
Last Name:EKANEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 CHARBONO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4813
Mailing Address - Country:US
Mailing Address - Phone:650-248-1108
Mailing Address - Fax:
Practice Address - Street 1:7401 MAR VISTA WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1724
Practice Address - Country:US
Practice Address - Phone:916-560-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility