Provider Demographics
NPI:1124247580
Name:CADWALLADER, CLAUDIA J (LAC)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:J
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:891 PISMO ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4017
Mailing Address - Country:US
Mailing Address - Phone:805-466-6825
Mailing Address - Fax:805-466-6825
Practice Address - Street 1:891 PISMO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4017
Practice Address - Country:US
Practice Address - Phone:805-466-6825
Practice Address - Fax:805-466-6825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist