Healthcare Provider Details

I. General information

NPI: 1669796181
Provider Name (Legal Business Name): JULIA SUSANA SIU BAAS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax: 530-758-8490
Mailing address:
  • Phone: 530-758-2060
  • Fax: 530-758-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: