Provider Demographics
NPI:1518034362
Name:MCLEOD, JUDITH (NP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26441 FRESNO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-1512
Mailing Address - Country:US
Mailing Address - Phone:949-306-5462
Mailing Address - Fax:
Practice Address - Street 1:26441 FRESNO DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-1512
Practice Address - Country:US
Practice Address - Phone:949-306-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255760163WL0100X
CANP4265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant