Provider Demographics
NPI:1124299623
Name:CUDIAMAT, CECILIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:
Last Name:CUDIAMAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90221-2143
Mailing Address - Country:US
Mailing Address - Phone:310-635-5223
Mailing Address - Fax:310-635-2846
Practice Address - Street 1:711 E ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:EAST RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90221-2143
Practice Address - Country:US
Practice Address - Phone:310-635-5223
Practice Address - Fax:310-635-2846
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16619363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical