Healthcare Provider Details

I. General information

NPI: 1356925564
Provider Name (Legal Business Name): MRS. JULIE WOOTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 06/06/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12347 LEWIS ST. SUITE 200
GARDEN GROVE CA
92840
US

IV. Provider business mailing address

12347 LEWIS ST. SUITE 200
GARDEN GROVE CA
92840
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0118
  • Fax:
Mailing address:
  • Phone: 714-202-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number17212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: