Provider Demographics
NPI:1689892739
Name:GALANTER, JUDY (REGISTERED DIETICIAN)
Entity Type:Individual
Prefix:MISS
First Name:JUDY
Middle Name:
Last Name:GALANTER
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 META ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7182
Mailing Address - Country:US
Mailing Address - Phone:805-487-5351
Mailing Address - Fax:
Practice Address - Street 1:650 META ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7182
Practice Address - Country:US
Practice Address - Phone:805-487-5351
Practice Address - Fax:805-484-2599
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL13309OtherCOMMISSION ON DIETETIC RE
CA952662606OtherEPDB TAX ID
CAFHC70769FMedicaid