Provider Demographics
NPI:1790385250
Name:SUDYKA, DAVID CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:SUDYKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11229 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-7750
Mailing Address - Country:US
Mailing Address - Phone:909-507-8420
Mailing Address - Fax:
Practice Address - Street 1:11229 HIGHVIEW DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-7750
Practice Address - Country:US
Practice Address - Phone:909-507-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAAMFT142062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty