Healthcare Provider Details

I. General information

NPI: 1982608733
Provider Name (Legal Business Name): JULIE A LONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD STE 200
PLEASANTON CA
94588-8564
US

IV. Provider business mailing address

4626 WILLOW RD STE 200
PLEASANTON CA
94588-8564
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number015021
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number015021
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: