Provider Demographics
NPI:1487488276
Name:AKPUDIOGWU, CHIDERA ISABELLA IV
Entity type:Individual
Prefix:
First Name:CHIDERA
Middle Name:ISABELLA
Last Name:AKPUDIOGWU
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 W IMPERIAL HWY APT 3
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3169
Mailing Address - Country:US
Mailing Address - Phone:310-261-5430
Mailing Address - Fax:
Practice Address - Street 1:2535 W IMPERIAL HWY APT 3
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3169
Practice Address - Country:US
Practice Address - Phone:310-261-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY4367171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst