Provider Demographics
NPI:1053015149
Name:KIVOWITZ, JUDITH ELLEN
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELLEN
Last Name:KIVOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1071
Mailing Address - Country:US
Mailing Address - Phone:415-378-6104
Mailing Address - Fax:
Practice Address - Street 1:628 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1071
Practice Address - Country:US
Practice Address - Phone:415-378-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398507163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse