Provider Demographics
NPI:1851422539
Name:HOAGLUND, JUDITH A (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:HOAGLUND
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 LAGUNA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3741
Mailing Address - Country:US
Mailing Address - Phone:707-829-9017
Mailing Address - Fax:
Practice Address - Street 1:365 TESCONI CIR # B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4617
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:707-575-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP55427Medicare UPIN