Healthcare Provider Details

I. General information

NPI: 1225450356
Provider Name (Legal Business Name): ROCHELLE JUDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD
CULVER CITY CA
90232-2732
US

IV. Provider business mailing address

9808 VENICE BLVD
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-945-3356
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95406649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: