Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A065666 | CA |
NPI | 1558474429 |
---|---|
Provider Name | Cecilia Matilda Jude |
First Address | Sylmar, CA 91342-1437 |
Second Address | Sylmar, CA 91342-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 13/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H66488 | (02) |