Provider Demographics
NPI:1407024185
Name:MADUABUCHI, VICTOR (PROGRAM MANAGER)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:MADUABUCHI
Suffix:
Gender:M
Credentials:PROGRAM MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15222 ERIEL AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4019
Mailing Address - Country:US
Mailing Address - Phone:310-644-1288
Mailing Address - Fax:310-856-4705
Practice Address - Street 1:15222 ERIEL AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4019
Practice Address - Country:US
Practice Address - Phone:310-644-1288
Practice Address - Fax:310-856-4705
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)