Healthcare Provider Details

I. General information

NPI: 1861304156
Provider Name (Legal Business Name): MANUEL OSVALDO CUADROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

IV. Provider business mailing address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

V. Phone/Fax

Practice location:
  • Phone: 213-629-6200
  • Fax: 213-289-7879
Mailing address:
  • Phone: 213-629-6200
  • Fax: 213-289-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: