Provider Demographics
NPI:1487733655
Name:HUDACEK, ANN MARIE (DPM)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:HUDACEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CASS ST SUITE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-648-1011
Mailing Address - Fax:831-648-1034
Practice Address - Street 1:1011 CASS ST SUITE 201
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-648-1011
Practice Address - Fax:831-648-1034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3903213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2784826Medicaid
CA2784826Medicaid
U47032Medicare UPIN
CA1207740001Medicare NSC