Provider Demographics
NPI:1942890660
Name:EZEOFOR HARRIS, IJEOMA (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:
Last Name:EZEOFOR HARRIS
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SANTA ROSALIA DR UNIT 1057
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3603
Mailing Address - Country:US
Mailing Address - Phone:323-538-2273
Mailing Address - Fax:
Practice Address - Street 1:3701 SANTA ROSALIA DR UNIT 1057
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3603
Practice Address - Country:US
Practice Address - Phone:323-538-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29848103TC1900X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical