Provider Demographics
NPI:1750396321
Name:SONYA, AGAEZI ODOCHI (DC)
Entity type:Individual
Prefix:DR
First Name:AGAEZI
Middle Name:ODOCHI
Last Name:SONYA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 WASHINGTON AVE STE C110-259
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2275
Mailing Address - Country:US
Mailing Address - Phone:951-387-4629
Mailing Address - Fax:951-387-4659
Practice Address - Street 1:25499 MARVIN GARDENS WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5420
Practice Address - Country:US
Practice Address - Phone:951-226-1846
Practice Address - Fax:951-226-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29166111N00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty