Provider Demographics
NPI:1053477216
Name:JUDELSON, JENNIFER J (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:JUDELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 860
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4225
Mailing Address - Country:US
Mailing Address - Phone:714-835-6500
Mailing Address - Fax:714-541-6105
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 860
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4225
Practice Address - Country:US
Practice Address - Phone:714-835-6500
Practice Address - Fax:714-541-6105
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant