Healthcare Provider Details

I. General information

NPI: 1699885038
Provider Name (Legal Business Name): GERARDO CUDICH L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GERARDO CUDICH

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAN FERNANDO RD STE.E
SAN FERNANDO CA
91340-3321
US

IV. Provider business mailing address

820 SAN FERNANDO RD STE.E
SAN FERNANDO CA
91340-3321
US

V. Phone/Fax

Practice location:
  • Phone: 818-837-4435
  • Fax:
Mailing address:
  • Phone: 818-837-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: