Provider Demographics
NPI:1851048714
Name:CUDA, ELI CLOVER
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:CLOVER
Last Name:CUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNAE
Other - Middle Name:ELIZABETH
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 N AINSWORTH ST APT 66
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4776
Mailing Address - Country:US
Mailing Address - Phone:503-475-6940
Mailing Address - Fax:
Practice Address - Street 1:1219 SE LAFAYETTE ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3802
Practice Address - Country:US
Practice Address - Phone:503-765-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program