Provider Demographics
NPI:1053146241
Name:IBE, CHIOMA UGOCHI (MSC, MAPM, MA)
Entity type:Individual
Prefix:MISS
First Name:CHIOMA
Middle Name:UGOCHI
Last Name:IBE
Suffix:
Gender:F
Credentials:MSC, MAPM, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BUENA VISTA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4108
Mailing Address - Country:US
Mailing Address - Phone:415-417-4273
Mailing Address - Fax:415-795-4798
Practice Address - Street 1:815 BUENA VISTA AVE W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4108
Practice Address - Country:US
Practice Address - Phone:415-417-4273
Practice Address - Fax:415-795-4798
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker