Provider Demographics
NPI:1326589920
Name:DIEP, JUDY (RN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DIEP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18410 SATICOY ST
Mailing Address - Street 2:APT 4
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3256
Mailing Address - Country:US
Mailing Address - Phone:626-478-6939
Mailing Address - Fax:
Practice Address - Street 1:221 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-4073
Practice Address - Fax:310-267-1996
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765219163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health