Provider Demographics
NPI:1982637518
Name:UGWUEZE, CHIDI J
Entity Type:Individual
Prefix:
First Name:CHIDI
Middle Name:J
Last Name:UGWUEZE
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 1:3925 W ROSECRANS AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-263-0062
Mailing Address - Fax:310-263-1615
Practice Address - Street 1:3925 W ROSECRANS AVENUE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-263-0062
Practice Address - Fax:310-263-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44127332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44127OtherHOME MEDICAL DEVICE RETAI
CA44127OtherHOME MEDICAL DEVICE RETAI