Healthcare Provider Details

I. General information

NPI: 1750396321
Provider Name (Legal Business Name): AGAEZI ODOCHI SONYA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25499 MARVIN GARDENS WAY
MURRIETA CA
92563-5420
US

IV. Provider business mailing address

23811 WASHINGTON AVE STE C110-259
MURRIETA CA
92562-2275
US

V. Phone/Fax

Practice location:
  • Phone: 951-226-1846
  • Fax: 951-226-1728
Mailing address:
  • Phone: 951-387-4629
  • Fax: 951-387-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: