Healthcare Provider Details

I. General information

NPI: 1760157010
Provider Name (Legal Business Name): LAWSON CUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 CENTER AVE STE 160
RANCHO CUCAMONGA CA
91730-5838
US

IV. Provider business mailing address

111 BUCKNELL AVE
CLAREMONT CA
91711-4953
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax: 858-649-6012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: