Provider Demographics
NPI:1740974518
Name:OBIDIKE, MARYANN NGOZI (MHM)
Entity type:Individual
Prefix:
First Name:MARYANN NGOZI
Middle Name:
Last Name:OBIDIKE
Suffix:
Gender:F
Credentials:MHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 WYATT ROLAND WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2657
Mailing Address - Country:US
Mailing Address - Phone:337-534-3839
Mailing Address - Fax:
Practice Address - Street 1:150 E 10TH ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5909
Practice Address - Country:US
Practice Address - Phone:909-621-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker