Provider Demographics
NPI:1821806902
Name:OPUDO, GEORGE O
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:O
Last Name:OPUDO
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 1:2105 N LOS ALTOS DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2134
Mailing Address - Country:US
Mailing Address - Phone:520-340-1891
Mailing Address - Fax:
Practice Address - Street 1:2105 N LOS ALTOS DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2134
Practice Address - Country:US
Practice Address - Phone:520-340-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD1A50Z344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi