Provider Demographics
NPI:1841472776
Name:UDOH, EKAETE DANIEL (PA - C)
Entity type:Individual
Prefix:
First Name:EKAETE
Middle Name:DANIEL
Last Name:UDOH
Suffix:
Gender:M
Credentials:PA - C
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Other - Credentials:
Mailing Address - Street 1:4036 UTAH ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-7929
Mailing Address - Country:US
Mailing Address - Phone:619-857-9284
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NMCSD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant