Healthcare Provider Details

I. General information

NPI: 1336618313
Provider Name (Legal Business Name): JULIETTE BEUCLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 EXCISE AVE STE 116
ONTARIO CA
91761-8557
US

IV. Provider business mailing address

206 N JACKSON ST
GLENDALE CA
91206-4330
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-241-6853
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: