Healthcare Provider Details

I. General information

NPI: 1841281235
Provider Name (Legal Business Name): SUZANNE E. CUDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W SUNSET RD STE 100
SAN ANTONIO TX
78209-2659
US

IV. Provider business mailing address

143 W SUNSET RD STE 100
SAN ANTONIO TX
78209-2659
US

V. Phone/Fax

Practice location:
  • Phone: 210-375-9685
  • Fax: 877-325-2479
Mailing address:
  • Phone: 210-375-9685
  • Fax: 877-325-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberP4295
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License NumberP4295
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: