Healthcare Provider Details

I. General information

NPI: 1033023130
Provider Name (Legal Business Name): JACOB CUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16708 S 22ND ST
PHOENIX AZ
85048-8154
US

IV. Provider business mailing address

16708 S 22ND ST
PHOENIX AZ
85048-8154
US

V. Phone/Fax

Practice location:
  • Phone: 951-472-6130
  • Fax:
Mailing address:
  • Phone: 951-472-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number45357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: