Healthcare Provider Details

I. General information

NPI: 1649165127
Provider Name (Legal Business Name): JULIAN PARENT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

V. Phone/Fax

Practice location:
  • Phone: 619-644-3030
  • Fax:
Mailing address:
  • Phone: 619-644-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: