Provider Demographics
NPI:1871172445
Name:AKUBUILO, NJIDEKA LAURA (NP)
Entity type:Individual
Prefix:
First Name:NJIDEKA
Middle Name:LAURA
Last Name:AKUBUILO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17919 MACKESON CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1629
Mailing Address - Country:US
Mailing Address - Phone:847-370-0079
Mailing Address - Fax:
Practice Address - Street 1:14500 MCNAB AVE APT 2416
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3388
Practice Address - Country:US
Practice Address - Phone:847-370-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine