Provider Demographics
NPI:1114017407
Name:MATES, JUDITH LEONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LEONG
Last Name:MATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:236 W PORTAL AVE
Mailing Address - Street 2:#342
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1427
Mailing Address - Country:US
Mailing Address - Phone:415-566-1632
Mailing Address - Fax:415-566-1878
Practice Address - Street 1:236 W PORTAL AVE
Practice Address - Street 2:#342
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1427
Practice Address - Country:US
Practice Address - Phone:415-566-1632
Practice Address - Fax:415-566-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0020343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology