=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396831145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH M BEDOY M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3975 JACKSON ST STE 207
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-352-2092
-----------------------------------------------------
Fax | 951-352-1913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3975 JACKSON ST STE 207
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-352-2092
-----------------------------------------------------
Fax | 951-352-1913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A79434
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------