Healthcare Provider Details

I. General information

NPI: 1366757189
Provider Name (Legal Business Name): JULIA A EASTMAN DOM, CCH, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 N 5TH AVE SUITE 207
PHOENIX AZ
85013-3811
US

IV. Provider business mailing address

3411 N 5TH AVE SUITE 207
PHOENIX AZ
85013-3811
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-3484
  • Fax: 602-264-5803
Mailing address:
  • Phone: 602-283-3484
  • Fax: 602-264-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number778
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number614
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: