Healthcare Provider Details

I. General information

NPI: 1801237177
Provider Name (Legal Business Name): JULIANE YAEL CRUZ GOLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIANE YAEL CRUZ MD

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

12606 BURBANK BLVD APT 5
VALLEY VILLAGE CA
91607-4756
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5896
  • Fax:
Mailing address:
  • Phone: 949-413-9449
  • Fax: 310-533-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA141479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number141479
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: