Provider Demographics
NPI:1780049015
Name:UDECHIME, EMMANUEL E
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:E
Last Name:UDECHIME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 MARCY RTE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3665
Mailing Address - Country:US
Mailing Address - Phone:571-501-5965
Mailing Address - Fax:
Practice Address - Street 1:2319 MARCY RTE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3665
Practice Address - Country:US
Practice Address - Phone:571-501-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide