Provider Demographics
NPI:1073730255
Name:DALTON, JUDITH MARY (RD)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARY
Last Name:DALTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10339 ESCONDIDO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4894
Mailing Address - Country:US
Mailing Address - Phone:661-268-1519
Mailing Address - Fax:661-268-1984
Practice Address - Street 1:10339 ESCONDIDO CANYON RD
Practice Address - Street 2:
Practice Address - City:AGUA DULCE
Practice Address - State:CA
Practice Address - Zip Code:91390-4894
Practice Address - Country:US
Practice Address - Phone:661-268-1519
Practice Address - Fax:661-268-1984
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL443942133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered