Provider Demographics
NPI:1861883365
Name:JUDGE, KIMBERLI
Entity type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-9610
Mailing Address - Country:US
Mailing Address - Phone:925-294-2700
Mailing Address - Fax:
Practice Address - Street 1:7011 EAST AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9610
Practice Address - Country:US
Practice Address - Phone:925-525-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor