Healthcare Provider Details

I. General information

NPI: 1033527908
Provider Name (Legal Business Name): JULI WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 KUCK LN
PETALUMA CA
94952-9606
US

IV. Provider business mailing address

365 KUCK LN
PETALUMA CA
94952-9606
US

V. Phone/Fax

Practice location:
  • Phone: 707-795-6954
  • Fax: 707-769-8469
Mailing address:
  • Phone: 707-795-6954
  • Fax: 707-769-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: