Healthcare Provider Details

I. General information

NPI: 1538444914
Provider Name (Legal Business Name): JENNIFER UDEOCHU D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W 8TH ST STE 100
LOS ANGELES CA
90017-4422
US

IV. Provider business mailing address

19707 REINHART AVE
CARSON CA
90746-2330
US

V. Phone/Fax

Practice location:
  • Phone: 213-401-1970
  • Fax:
Mailing address:
  • Phone: 323-702-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: