Healthcare Provider Details

I. General information

NPI: 1952500027
Provider Name (Legal Business Name): JULIA MIZENER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA CORRAL MD

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

25727 MCBEAN PARKWAY NICU
VALENCIA CA
91355-2600
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax:
Mailing address:
  • Phone: 661-200-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA100451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: