MEDICARE: JULIETTA GHUKASYAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA66815	CA

General Provider Information

NPI Number	:	1063125284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETTA GHUKASYAN PA-C

Provider Business Mailing Address
First Line	:	3838 CALIFORNIA ST RM 300
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1505
Country	:	US
Telephone Number	:	415-600-5400
Fax Number	:	415-387-0730

Provider Business Practice Location Address
First Line	:	3838 CALIFORNIA ST RM 300
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1505
Country	:	US
Telephone Number	:	415-600-5400
Fax Number	:	415-387-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	11/12/2025

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