Provider Demographics
NPI:1508195942
Name:CHUDAK, JULIE (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHUDAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23200 BEAR VALLEY RD
Mailing Address - Street 2:SP 4
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-7431
Mailing Address - Country:US
Mailing Address - Phone:760-987-7421
Mailing Address - Fax:
Practice Address - Street 1:23200 BEAR VALLEY RD
Practice Address - Street 2:SP 4
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-7431
Practice Address - Country:US
Practice Address - Phone:760-987-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered