1689892739 NPI number — MISS JUDY GALANTER REGISTERED DIETICIAN

Table of content: MISS JUDY GALANTER REGISTERED DIETICIAN (NPI 1689892739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689892739 NPI number — MISS JUDY GALANTER REGISTERED DIETICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALANTER
Provider First Name:
JUDY
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689892739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 META ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030-7182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-487-5351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 META ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-7182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-487-5351
Provider Business Practice Location Address Fax Number:
805-484-2599
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  13309 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13309 . This is a "COMMISSION ON DIETETIC RE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 952662606 . This is a "EPDB TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC70769F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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