Healthcare Provider Details

I. General information

NPI: 1912622952
Provider Name (Legal Business Name): DR. JUDY MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE P3
COSTA MESA CA
92626-4626
US

IV. Provider business mailing address

3151 AIRWAY AVE STE P3
COSTA MESA CA
92626-4626
US

V. Phone/Fax

Practice location:
  • Phone: 949-929-5061
  • Fax:
Mailing address:
  • Phone: 949-929-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: