Healthcare Provider Details

I. General information

NPI: 1659933554
Provider Name (Legal Business Name): JULIA BUDNIAK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 42ND STREET CT W
UNIVERSITY PLACE WA
98466-2402
US

IV. Provider business mailing address

9040 JACKSON STREET
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-633-0379
  • Fax:
Mailing address:
  • Phone: 253-968-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number60985015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: