Healthcare Provider Details

I. General information

NPI: 1275878233
Provider Name (Legal Business Name): JULISSA TRUSTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10653 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2341
US

IV. Provider business mailing address

10653 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2341
US

V. Phone/Fax

Practice location:
  • Phone: 818-850-1879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94024374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: