Provider Demographics
NPI:1902048382
Name:JUDGE, TANYA JOE (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JOE
Last Name:JUDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAINA TANYA
Other - Middle Name:JOE
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11820 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2830
Mailing Address - Country:US
Mailing Address - Phone:925-875-0700
Mailing Address - Fax:
Practice Address - Street 1:11820 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2830
Practice Address - Country:US
Practice Address - Phone:925-875-0700
Practice Address - Fax:925-875-0700
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1177072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery