Individual
IMO ASUQUO EBONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.,M.S.
Contact information
Practice address
4860 Y ST STE 2860, SACRAMENTO, CA 95817-2307
(916) 734-8426
(916) 734-6474
Mailing address
4860 Y ST STE 2860, SACRAMENTO, CA 95817-2307
(916) 734-8426
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A119607
CA
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
A119607
CA
207RC0000X
Cardiovascular Disease Physician
A119607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902846306
GROUP NPI
CA
01
—
GR0100430
GROUP MEDI-CAL
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
05/18/2008
Last updated
02/21/2024
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