Healthcare Provider Details

I. General information

NPI: 1437093721
Provider Name (Legal Business Name): TAYLR MARIE JUDKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 RUNNYMEDE ST
VAN NUYS CA
91405-1435
US

IV. Provider business mailing address

7426 BELMAR AVE
RESEDA CA
91335-8022
US

V. Phone/Fax

Practice location:
  • Phone: 818-389-1184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: