Provider Demographics
NPI:1790757136
Name:JUDELSON, DEBRA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:JUDELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:STE 1100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-278-3400
Mailing Address - Fax:310-278-1240
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:STE 1100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-278-3400
Practice Address - Fax:310-278-1240
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35161207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G351610Medicaid
CA00G351610Medicaid
CAA46237Medicare UPIN