Provider Demographics
NPI:1598599003
Name:IGWE, CHUKWUMA
Entity type:Individual
Prefix:
First Name:CHUKWUMA
Middle Name:
Last Name:IGWE
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 1:14148 CALLE DOMINGO
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5452
Mailing Address - Country:US
Mailing Address - Phone:424-356-4350
Mailing Address - Fax:
Practice Address - Street 1:14148 CALLE DOMINGO
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-5452
Practice Address - Country:US
Practice Address - Phone:424-356-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver