Healthcare Provider Details

I. General information

NPI: 1740549278
Provider Name (Legal Business Name): CAMBRIA ANNE JUDD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 100
NEWPORT BEACH CA
92663
US

IV. Provider business mailing address

2100 MAIN ST STE 360
IRVINE CA
92614-6265
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-3300
  • Fax:
Mailing address:
  • Phone: 949-566-8414
  • Fax: 949-872-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA136590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: