Healthcare Provider Details

I. General information

NPI: 1215975776
Provider Name (Legal Business Name): SARAH A JUDD M.D., FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY MC-5075
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3860 CALLE FORTUNADA SUITE #210
SAN DIEGO CA
92123-4800
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8800
  • Fax:
Mailing address:
  • Phone: 858-309-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number054398
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN4877
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME100594
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC54689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: