Healthcare Provider Details

I. General information

NPI: 1891974655
Provider Name (Legal Business Name): JULIA BERYL WILLNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 130
ORANGE CA
92868-3216
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6707
  • Fax:
Mailing address:
  • Phone: 714-456-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA96859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: