Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY13763 | CA |
Y | 103T00000X | Psychologist | PSY13763 | CA |
NPI | 1013047638 |
---|---|
Provider Name | Dr. Elena Rose Judd |
First Address | Los Angeles, CA 90038-3805 |
Second Address | Los Angeles, CA 90038-3805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 11/09/2012 |