Provider Demographics
NPI:1669550471
Name:UDEKWU, MARIE I (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:I
Last Name:UDEKWU
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:PO BOX 33285
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-3285
Mailing Address - Country:US
Mailing Address - Phone:408-354-9254
Mailing Address - Fax:918-213-4399
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:408-354-9254
Practice Address - Fax:918-213-4399
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50757207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A507570Medicaid
CA00A507570Medicaid
00A507570Medicare ID - Type Unspecified