Provider Demographics
NPI:1023383510
Name:UMAH-MGBOROGWU, DISEPH TOMI
Entity type:Individual
Prefix:
First Name:DISEPH
Middle Name:TOMI
Last Name:UMAH-MGBOROGWU
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 1:20 W LUGONIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2234
Mailing Address - Country:US
Mailing Address - Phone:626-251-0989
Mailing Address - Fax:
Practice Address - Street 1:20 W LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2234
Practice Address - Country:US
Practice Address - Phone:626-251-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist