Individual
AUGUSTA UAYEMEN IKHISEMOJIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6485 DAY ST STE 305, RIVERSIDE, CA 92507
(951) 413-6433
(951) 413-6633
Mailing address
PO BOX 60790, PASADENA, CA 91116-6790
(626) 795-6596
(770) 701-6655
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
CA
207L00000X
Anesthesiology Physician
A67133
CA
207Q00000X
Family Medicine Physician
P1462
TX
208VP0000X
Pain Medicine Physician
Primary
A67133
CA
208VP0000X
Pain Medicine Physician
P1462
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A671330
BLUE SHIELD
CA
05
—
00A671330
—
CA
01
—
P1462
MEDICARE ID - TYPE UNSPECIFIED
TX
Enumeration date
06/30/2006
Last updated
09/18/2018
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