Healthcare Provider Details

I. General information

NPI: 1093580425
Provider Name (Legal Business Name): STEPHEN CHRISTOPHER CARDOZA SUDRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W BEAMER ST
WOODLAND CA
95695-2510
US

IV. Provider business mailing address

215 W BEAMER ST
WOODLAND CA
95695-2510
US

V. Phone/Fax

Practice location:
  • Phone: 530-405-2800
  • Fax:
Mailing address:
  • Phone: 530-709-5012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: