Provider Demographics
NPI:1962148619
Name:IKWUEZUNMA, IJEZIE (MD)
Entity type:Individual
Prefix:
First Name:IJEZIE
Middle Name:
Last Name:IKWUEZUNMA
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 1:13003 LAKEVIEW MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-8372
Mailing Address - Country:US
Mailing Address - Phone:832-359-1758
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST STE 3800
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:832-359-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program