Healthcare Provider Details

I. General information

NPI: 1326043894
Provider Name (Legal Business Name): JUDY R. ADLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVE STE 220
SAN DIEGO CA
92103-2120
US

IV. Provider business mailing address

7920 FROST ST STE 300
SAN DIEGO CA
92123-2736
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-2350
  • Fax: 619-297-8379
Mailing address:
  • Phone: 858-499-1900
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG56817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: