Provider Demographics
NPI:1053908194
Name:ECHEGI, OKWUDIRI
Entity type:Individual
Prefix:MRS
First Name:OKWUDIRI
Middle Name:
Last Name:ECHEGI
Suffix:
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 1:1444 CARLY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8764
Mailing Address - Country:US
Mailing Address - Phone:209-605-6817
Mailing Address - Fax:
Practice Address - Street 1:1444 CARLY CREEK DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8764
Practice Address - Country:US
Practice Address - Phone:209-605-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59468363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical