Provider Demographics
NPI:1679575229
Name:FRIED, JUDITH (RD, CDE)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 N TENAYA WAY
Mailing Address - Street 2:2ND FLOOR OFFICE 232 A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0424
Mailing Address - Country:US
Mailing Address - Phone:702-242-7533
Mailing Address - Fax:702-258-3563
Practice Address - Street 1:2716 N TENAYA WAY
Practice Address - Street 2:2ND FLOOR OFFICE 232 A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-242-7533
Practice Address - Fax:702-258-3563
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered