Provider Demographics
NPI:1467610287
Name:EZIMORA, JUDITH UCHENNA
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:UCHENNA
Last Name:EZIMORA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDITH EUCHARIA
Other - Middle Name:UCHENNA
Other - Last Name:EZIMORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4801 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820
Mailing Address - Country:US
Mailing Address - Phone:916-359-1616
Mailing Address - Fax:
Practice Address - Street 1:4801 34TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4849
Practice Address - Country:US
Practice Address - Phone:916-737-9202
Practice Address - Fax:916-737-0262
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical