Healthcare Provider Details

I. General information

NPI: 1205352556
Provider Name (Legal Business Name): JULIE ANN PELLMAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VETERANS PARKWAY
BARSTOW CA
92311
US

IV. Provider business mailing address

100 VETERANS PKWY
BARSTOW CA
92311-7003
US

V. Phone/Fax

Practice location:
  • Phone: 760-252-6212
  • Fax:
Mailing address:
  • Phone: 760-252-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number865807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: