Individual
JUDY A WEIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2940 INLAND EMPIRE BLVD, ONTARIO, CA 91764-4898
(909) 421-9301
(909) 421-9219
Mailing address
2940 INLAND EMPIRE BLVD, ONTARIO, CA 91764-4898
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518406495
MEDI-CAL
CA
05
—
1518406495
—
CA
Enumeration date
02/13/2017
Last updated
06/06/2025
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