Healthcare Provider Details

I. General information

NPI: 1073829446
Provider Name (Legal Business Name): CYNTHIA MARIE CAUDILLO RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA MARIE HILDEBRAND

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4934
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-948-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1732
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: