Provider Demographics
NPI:1811318884
Name:JUDAH, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JUDAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13391 CALIFORNIA ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5105
Mailing Address - Country:US
Mailing Address - Phone:951-777-2525
Mailing Address - Fax:951-777-2517
Practice Address - Street 1:13391 CALIFORNIA ST
Practice Address - Street 2:SUITE 6
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5105
Practice Address - Country:US
Practice Address - Phone:951-777-2525
Practice Address - Fax:951-777-2517
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based