Basic Information
| Provider Information | |||||||||
| NPI: | 1225072150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEMPEL | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 SAN PABLO ST | ||||||||
| Address2: | SUITE 3451 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900335310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234427400 | ||||||||
| FaxNumber: | 3234427411 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 W OLYMPIC BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106575900 | ||||||||
| FaxNumber: | 3239325376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3050 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN0030500 | 05 | CA | MEDICAID | RN0030500328 | 01 | CA | CALOPTIMA | OTHER | NA0030500 | 01 | CA | BLUE SHIELD | OTHER |