Provider Demographics
NPI:1326263245
Name:GERGIS, JUDITH C (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:C
Last Name:GERGIS
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
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Mailing Address - Street 1:72 MOODY CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-777-3500
Mailing Address - Fax:805-777-3510
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:SUITE 102
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3500
Practice Address - Fax:805-777-3510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA253831163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult