Provider Demographics
NPI:1891882221
Name:UWEDJOJEVWE, LETICIA MARITZA (MD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MARITZA
Last Name:UWEDJOJEVWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 4TH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-934-2215
Mailing Address - Fax:619-934-2340
Practice Address - Street 1:340 4TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-934-2215
Practice Address - Fax:619-934-2340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A803290Medicaid
CAG89043Medicare UPIN
CAWA80329CMedicare ID - Type UnspecifiedMEDICARE