Provider Demographics
NPI:1558474429
Name:JUDE, CECILIA MATILDA (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MATILDA
Last Name:JUDE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:DEPT OF RADIOLOGY, 2D115
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:818-364-4079
Mailing Address - Fax:818-364-4071
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:DEPT OF RADIOLOGY 2D115
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-4079
Practice Address - Fax:818-364-4071
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-02-13
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Provider Licenses
StateLicense IDTaxonomies
CAA065666207U00000X, 2085B0100X, 2085R0202X
CAA656662085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66488Medicare UPIN