Provider Demographics
NPI:1154494177
Name:UDA, GEORGIANA (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGIANA
Middle Name:
Last Name:UDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GEORGIANA
Other - Middle Name:
Other - Last Name:UDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1635 SWEETWATER RD
Mailing Address - Street 2:STE G
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7600
Mailing Address - Country:US
Mailing Address - Phone:619-477-4111
Mailing Address - Fax:619-477-4105
Practice Address - Street 1:1635 SWEETWATER RD
Practice Address - Street 2:STE G
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7600
Practice Address - Country:US
Practice Address - Phone:619-477-4111
Practice Address - Fax:619-477-4105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16570DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor