Provider Demographics
NPI:1528185030
Name:UDEH, VICTORIA A (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:UDEH
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 1:8151 ARLINGTON AVE
Mailing Address - Street 2:SUITES U-V
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0436
Mailing Address - Country:US
Mailing Address - Phone:951-588-0861
Mailing Address - Fax:951-588-1910
Practice Address - Street 1:8856 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-1365
Practice Address - Country:US
Practice Address - Phone:951-353-2702
Practice Address - Fax:951-353-2976
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70324FOtherPACT
CAFHC71040FOtherMEDICAL
CAHAP71040FOtherPACT
CAFHC71040FOtherMEDICAL
CA051047Medicare ID - Type UnspecifiedMEDICARE