Basic Information
Provider Information
NPI: 1780898262
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NWAJEI
FirstName: PATRICK
MiddleName: OGOMEGBUNAM
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9300 VALLEY CHILDRENS PL # SC05
Address2:  
City: MADERA
State: CA
PostalCode: 936368761
CountryCode: US
TelephoneNumber: 5593535700
FaxNumber:  
Practice Location
Address1: 9300 VALLEY CHILDRENS PL
Address2:  
City: MADERA
State: CA
PostalCode: 936368761
CountryCode: US
TelephoneNumber: 5593535700
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2007
LastUpdateDate: 04/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001XA116597CAY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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