Provider Demographics
NPI:1386443174
Name:MAINA, JUDY W
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:W
Last Name:MAINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 N STATE COLLEGE BLVD APT 4082
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5731
Mailing Address - Country:US
Mailing Address - Phone:206-255-9987
Mailing Address - Fax:
Practice Address - Street 1:293 N STATE COLLEGE BLVD APT 4082
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5731
Practice Address - Country:US
Practice Address - Phone:206-255-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95348137163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical