Provider Demographics
NPI:1386759876
Name:VINOCUR, JUDITH ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELLEN
Last Name:VINOCUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2133
Mailing Address - Country:US
Mailing Address - Phone:818-461-8162
Mailing Address - Fax:818-461-8961
Practice Address - Street 1:16430 VENTURA BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2133
Practice Address - Country:US
Practice Address - Phone:818-461-8162
Practice Address - Fax:818-461-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG730642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07776Medicare UPIN
G73064Medicare ID - Type Unspecified