Provider Demographics
NPI:1639316904
Name:CUDIAMAT, GWENDOLINE R (OTR)
Entity Type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:R
Last Name:CUDIAMAT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WILSHIRE BLVD
Mailing Address - Street 2:211
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1136
Mailing Address - Country:US
Mailing Address - Phone:213-738-0999
Mailing Address - Fax:
Practice Address - Street 1:3000 WILSHIRE BLVD
Practice Address - Street 2:211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1136
Practice Address - Country:US
Practice Address - Phone:213-738-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9101225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist