Provider Demographics
NPI:1598960700
Name:IZUMI, JUDITH SANO (NP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SANO
Last Name:IZUMI
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 1:2332 PASEO DE CIMA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1037
Mailing Address - Country:US
Mailing Address - Phone:818-952-2096
Mailing Address - Fax:
Practice Address - Street 1:2332 PASEO DE CIMA
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1037
Practice Address - Country:US
Practice Address - Phone:818-952-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily