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NPI Code Detail

MEDICARE: ANA JULIA POPOCA-LOGUE N.P.

MEDICARE: ANA JULIA POPOCA-LOGUE N.P.
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
1363LF0000XFamily Nurse Practitioner524129CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner12900CA

General Provider Information

NPI Number : 1437262219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANA JULIA POPOCA-LOGUE N.P.
Provider Business Mailing Address
First Line : 5121 BAXTER ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-1302
Country : US
Telephone Number : 858-922-9991
Fax Number :
Provider Business Practice Location Address
First Line : 2650 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3439
Country : US
Telephone Number : 626-577-2261
Fax Number : 626-577-2543
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 06/23/2020

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