Provider Demographics
NPI:1679995716
Name:ANYEJI, ADAOBI I (PHD)
Entity Type:Individual
Prefix:
First Name:ADAOBI
Middle Name:I
Last Name:ANYEJI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W 5TH ST # 26002800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2005
Mailing Address - Country:US
Mailing Address - Phone:213-290-4183
Mailing Address - Fax:
Practice Address - Street 1:633 W 5TH ST # 26002800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2005
Practice Address - Country:US
Practice Address - Phone:213-290-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26828103TC0700X
NY021004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW-416OtherPCSD MEDICARE NUMBER