Provider Demographics
NPI:1689884579
Name:UWADIA, BETTY AIMIOHI (REGISTERED)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:AIMIOHI
Last Name:UWADIA
Suffix:
Gender:F
Credentials:REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3839
Mailing Address - Country:US
Mailing Address - Phone:909-278-3322
Mailing Address - Fax:909-397-4227
Practice Address - Street 1:324 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3839
Practice Address - Country:US
Practice Address - Phone:909-278-3322
Practice Address - Fax:909-397-4227
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor