Healthcare Provider Details

I. General information

NPI: 1063025898
Provider Name (Legal Business Name): JUDY S M LI RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SANTA ANITA AVE STE 800
ARCADIA CA
91006-3129
US

IV. Provider business mailing address

5518 N SANTA ANITA AVE
ARCADIA CA
91006-5601
US

V. Phone/Fax

Practice location:
  • Phone: 626-268-3340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-305949
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86114676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: