Healthcare Provider Details

I. General information

NPI: 1356100713
Provider Name (Legal Business Name): JUDD HEMBREE RADT 1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YOSEMITE PKWY
MERCED CA
95340-5203
US

IV. Provider business mailing address

687 TRUDY WAY
MERCED CA
95341-7006
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-6335
  • Fax: 209-722-6371
Mailing address:
  • Phone: 559-786-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1516370723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: