Provider Demographics
NPI:1851582985
Name:OGUAGHA, CHIEDU
Entity Type:Individual
Prefix:
First Name:CHIEDU
Middle Name:
Last Name:OGUAGHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 SPINNING AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1717
Mailing Address - Country:US
Mailing Address - Phone:323-752-9723
Mailing Address - Fax:
Practice Address - Street 1:1704 W MANCHESTER AVE STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3057
Practice Address - Country:US
Practice Address - Phone:323-752-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6151OtherCAS