Provider Demographics
NPI:1982831863
Name:CUDILO, ELIZABETH M (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:CUDILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:9300 VALLEY CHILDREN'S PLACE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-3000
Practice Address - Fax:212-746-8563
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY274345207L00000X
CA115153207L00000X
CAA115153207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA115153OtherCALIFORNIA MEDICAL LICENSE
NY274345OtherNEW YORK MEDICAL LICENSE
CACA166124Medicare PIN