Provider Demographics
NPI:1992455976
Name:HUDDY, CHRISTIE NOELANI
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:NOELANI
Last Name:HUDDY
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 1:1410 PASEO GRACIA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18740 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6353
Practice Address - Country:US
Practice Address - Phone:818-708-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2023-08-22
Deactivation Date:2022-11-30
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
CA95019818363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care