Provider Demographics
NPI:1538537535
Name:UQDAH, DIMITRIA (RADT1)
Entity type:Individual
Prefix:
First Name:DIMITRIA
Middle Name:
Last Name:UQDAH
Suffix:
Gender:F
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4750
Mailing Address - Country:US
Mailing Address - Phone:661-208-4699
Mailing Address - Fax:661-208-4761
Practice Address - Street 1:1050 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4750
Practice Address - Country:US
Practice Address - Phone:661-208-4699
Practice Address - Fax:661-208-4761
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS0245101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)