Provider Demographics
NPI:1447560982
Name:SHASHOUA, JUDITH (LAC , MSOM,DAOM(C))
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:SHASHOUA
Suffix:
Gender:F
Credentials:LAC , MSOM,DAOM(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 CORTEEN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2592
Mailing Address - Country:US
Mailing Address - Phone:818-770-6368
Mailing Address - Fax:
Practice Address - Street 1:5252 CORTEEN PL APT 25
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4200
Practice Address - Country:US
Practice Address - Phone:818-770-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist