Healthcare Provider Details

I. General information

NPI: 1740129188
Provider Name (Legal Business Name): JULIS ERICA KISHIMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 N MARVIN ST
GILBERT AZ
85233-2555
US

IV. Provider business mailing address

1159 N MARVIN ST
GILBERT AZ
85233-2555
US

V. Phone/Fax

Practice location:
  • Phone: 480-462-9423
  • Fax:
Mailing address:
  • Phone: 480-462-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberI027017
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: