Healthcare Provider Details

I. General information

NPI: 1114651981
Provider Name (Legal Business Name): MERCY EKEOMA AZUBUKO-UDAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

3649 GARNET ST APT 156
TORRANCE CA
90503-3350
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-8000
  • Fax:
Mailing address:
  • Phone: 310-350-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: