Basic Information
Provider Information | |||||||||
NPI: | 1215975776 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JUDD | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D., FAAP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3860 CALLE FORTUNADA | ||||||||
Address2: | SUITE #210 | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921234800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8583096290 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3020 CHILDRENS WAY | ||||||||
Address2: | MC-5075 | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921234223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8589668800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/04/2006 | ||||||||
LastUpdateDate: | 11/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 054398 | GA | N |   | Other Service Providers | Legal Medicine |   | 208000000X | N4877 | TX | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | ME100594 | FL | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | C54689 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 280435200 | 05 | FL |   | MEDICAID | 2155608 | 05 | TX |   | MEDICAID | 854480525A | 05 | GA |   | MEDICAID |