Provider Demographics
NPI:1265122857
Name:GUDJOHNSEN, CLAUDIA GIOVANNA (PA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:GIOVANNA
Last Name:GUDJOHNSEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 TECHNOLOGY DR UNIT B107
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT B107
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6338
Practice Address - Country:US
Practice Address - Phone:203-268-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant