Provider Demographics
NPI:1184992851
Name:OKPARA, IZUCHUKWU DANIEL (MD)
Entity type:Individual
Prefix:
First Name:IZUCHUKWU
Middle Name:DANIEL
Last Name:OKPARA
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 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:661-383-7136
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:213-228-3538
Practice Address - Fax:818-356-4380
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0292208600000X
FLME158300208600000X
CAA126340208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01836601OtherMEDICARE RAILROAD
CACA246138OtherMEDICARE NORTH CALIFORNIA
CACB274828OtherMEDICARE SOUTH CALIFORNIA
CA1184992851Medicaid