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Individual

UWEM IME EKANEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7401 MAR VISTA WAY, CITRUS HEIGHTS, CA 95621-1724
(916) 560-3796
Mailing address
10609 CHARBONO WAY, RANCHO CORDOVA, CA 95670-4813
(650) 248-1108

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
12/29/2021
Last updated
10/21/2022
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