Healthcare Provider Details

I. General information

NPI: 1972788370
Provider Name (Legal Business Name): MR. UDOAMAKA OBIEKEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N HEARTHSTONE WAY APT 223
CHANDLER AZ
85226-0007
US

IV. Provider business mailing address

PO BOX 8217
CHANDLER AZ
85246-8217
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-5593
  • Fax: 480-383-6338
Mailing address:
  • Phone: 480-544-5593
  • Fax: 480-383-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: