Provider Demographics
NPI:1285383117
Name:ANUGOM, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ANUGOM
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 1:13917 MCCLURE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-6011
Mailing Address - Country:US
Mailing Address - Phone:323-470-8879
Mailing Address - Fax:
Practice Address - Street 1:7451 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2803
Practice Address - Country:US
Practice Address - Phone:818-503-9800
Practice Address - Fax:818-503-9801
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019407363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health