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Individual

JUDITH LOUISE DETHLEFS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
815 POLLARD ROAD, LOS GATOS, CA 95032
(408) 378-6131
Mailing address
2100 POWELL STREET, STE 920, EMERYVILLE, CA 94608
(510) 350-2600
(510) 879-9100

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G35356
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G353560
CA
Enumeration date
05/23/2006
Last updated
07/11/2008
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