Provider Demographics
NPI:1699885038
Name:CUDICH, GERARDO (LAC)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:CUDICH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:
Other - Last Name:CUDICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:820 SAN FERNANDO RD
Mailing Address - Street 2:STE.E
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3321
Mailing Address - Country:US
Mailing Address - Phone:818-837-4435
Mailing Address - Fax:
Practice Address - Street 1:820 SAN FERNANDO RD
Practice Address - Street 2:STE.E
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3321
Practice Address - Country:US
Practice Address - Phone:818-837-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist