Provider Demographics
NPI:1932282696
Name:UDEORJI, MICHAEL C (BA,MPA, MSW09/29/194)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:UDEORJI
Suffix:
Gender:M
Credentials:BA,MPA, MSW09/29/194
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 DON ZAREMBO DR.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008
Mailing Address - Country:US
Mailing Address - Phone:310-668-5150
Mailing Address - Fax:310-223-0695
Practice Address - Street 1:1720 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3052
Practice Address - Country:US
Practice Address - Phone:310-668-5150
Practice Address - Fax:310-223-0695
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional