Healthcare Provider Details

I. General information

NPI: 1447654264
Provider Name (Legal Business Name): CUDDY INVESTMENTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 N SANTA FE AVE
COMPTON CA
90221-1427
US

IV. Provider business mailing address

1112 N SANTA FE AVE
COMPTON CA
90221-1427
US

V. Phone/Fax

Practice location:
  • Phone: 310-638-1100
  • Fax: 310-638-0008
Mailing address:
  • Phone: 310-638-1100
  • Fax: 310-638-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP21822
License Number StateCA

VIII. Authorized Official

Name: MS. JEANETTE MONIQUE KIDD
Title or Position: ONWER
Credential: FNP-C
Phone: 310-638-1100