Provider Demographics
NPI:1801370846
Name:PODUE, SYDNEY HANNAH
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:HANNAH
Last Name:PODUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16331 LUNAR ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7711
Mailing Address - Country:US
Mailing Address - Phone:714-717-1494
Mailing Address - Fax:
Practice Address - Street 1:4001 WESTERLY PL STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2302
Practice Address - Country:US
Practice Address - Phone:949-756-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician