Provider Demographics
NPI:1679395180
Name:CUDD-ZAMORA, TEREFECH ELIAS
Entity type:Individual
Prefix:
First Name:TEREFECH
Middle Name:ELIAS
Last Name:CUDD-ZAMORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2364
Mailing Address - Country:US
Mailing Address - Phone:612-819-3825
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE LL20
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2738
Practice Address - Country:US
Practice Address - Phone:612-259-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician