Healthcare Provider Details

I. General information

NPI: 1689884579
Provider Name (Legal Business Name): BETTY AIMIOHI UWADIA REGISTERED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N PARK AVE
POMONA CA
91768-3839
US

IV. Provider business mailing address

324 N PARK AVE
POMONA CA
91768-3839
US

V. Phone/Fax

Practice location:
  • Phone: 909-278-3322
  • Fax: 909-397-4227
Mailing address:
  • Phone: 909-278-3322
  • Fax: 909-397-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: