Mary Enyi Udengwu

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

19405 Issued in CA

Practice address

9808 Venice Blvd Ste 700
Culver City, CA 90232-6824

Phone

(310) 945-3350

Fax

(310) 945-3356

NPI assigned

Sep 14, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Exodus Recovery, Inc.

  • Community/Behavioral Health Agency
  • Orange, CA
  • NPI 1326641671
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1770816373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900891001",
            "telephone_number": "424-338-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD STE 700",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902326824",
            "telephone_number": "310-945-3350",
            "fax_number": "310-945-3356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4411 E Kings Canyon Rd",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937023604",
            "country_code": "US",
            "telephone_number": "559-453-1008",
            "fax_number": "559-512-8705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "265 S Anita Dr Ste 102-104",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683355",
            "country_code": "US",
            "telephone_number": "714-410-3500",
            "fax_number": "714-410-3526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDENGWU",
        "first_name": "MARY",
        "middle_name": "ENYI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "19405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ernest Chukwugozie Udeh
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• Kelsey Ueda
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• Jane Ugeh

• Psychiatric/Mental Health Nurse Practitioner in Culver City, CA
• Providers in Culver City, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.