Basic Information
| Provider Information | |||||||||
| NPI: | 1467479295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBIOCHA | ||||||||
| FirstName: | IKECHI | ||||||||
| MiddleName: | OBIOMA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8110 MANGO AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923353603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098221164 | ||||||||
| FaxNumber: | 9093572235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1851 N RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | RIALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923768069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098221164 | ||||||||
| FaxNumber: | 9093572235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A84056 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A840560 | 05 | CA | MEDICAID |