1972356434 NPI number — DR. IVIE CLEOPATRA EGIEBOR MD, DRPH, MPH

Table of content: DR. IVIE CLEOPATRA EGIEBOR MD, DRPH, MPH (NPI 1972356434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972356434 NPI number — DR. IVIE CLEOPATRA EGIEBOR MD, DRPH, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGIEBOR
Provider First Name:
IVIE
Provider Middle Name:
CLEOPATRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, DRPH, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGIEBOR
Provider Other First Name:
QUEEN-IVIE
Provider Other Middle Name:
CLEOPATRA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972356434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 WESTWOOD PLAZA, INTERNAL MEDICINE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095-7419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-825-7375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 WESTWOOD PLAZA, INTERNAL MEDICINE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-7419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-7375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)