Basic Information
| Provider Information | |||||||||
| NPI: | 1760669717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDZIOL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1640 | ||||||||
| Address2: | |||||||||
| City: | WEAVERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960931640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306231362 | ||||||||
| FaxNumber: | 5306231447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1979 BERKESEY LN | ||||||||
| Address2: | |||||||||
| City: | VALLEY SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097723765 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 77132 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.