Provider Demographics
NPI:1083665483
Name:BAILEY, JUDITH F (MS RD CDE)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:F
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 FOX CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6407
Mailing Address - Country:US
Mailing Address - Phone:925-933-3565
Mailing Address - Fax:
Practice Address - Street 1:2565 FOX CIR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-6407
Practice Address - Country:US
Practice Address - Phone:925-933-3565
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACDR720598133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered