Healthcare Provider Details

I. General information

NPI: 1891785234
Provider Name (Legal Business Name): JULIE S FALLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

IV. Provider business mailing address

2284 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

V. Phone/Fax

Practice location:
  • Phone: 310-414-9761
  • Fax:
Mailing address:
  • Phone: 310-414-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA78180
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA78180
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA78180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: