Provider Demographics
NPI:1467709790
Name:TATARYN, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:TATARYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:TATARYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2393 LINCOLN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2750
Mailing Address - Country:US
Mailing Address - Phone:408-448-6140
Mailing Address - Fax:
Practice Address - Street 1:1064 SERPENTINE LN STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4702
Practice Address - Country:US
Practice Address - Phone:925-226-2884
Practice Address - Fax:925-734-9600
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385984163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management