Provider Demographics
NPI:1396787156
Name:RUNELS, JUDY FLUOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:FLUOR
Last Name:RUNELS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-284-7573
Mailing Address - Fax:714-842-8330
Practice Address - Street 1:17822 BEACH BLVD.
Practice Address - Street 2:SUITE 230
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-284-7573
Practice Address - Fax:714-842-8330
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP20804AOtherMAC
CAWCP20804AMedicare PIN