Provider Demographics
NPI:1962099291
Name:ENERA5
Entity type:Organization
Organization Name:ENERA5
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MD
Authorized Official - Prefix:DR
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:O
Authorized Official - Last Name:ARENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-290-3289
Mailing Address - Street 1:11325 PARK SQUARE DR APT K202
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8869
Mailing Address - Country:US
Mailing Address - Phone:661-873-5887
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5200
Practice Address - Country:US
Practice Address - Phone:818-290-3289
Practice Address - Fax:818-290-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801806674Medicaid