Healthcare Provider Details

I. General information

NPI: 1285868323
Provider Name (Legal Business Name): JULIE JEYARATNAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 AIRPARK DR STE 201
REDDING CA
96001-2461
US

IV. Provider business mailing address

2510 AIRPARK DR STE 201
REDDING CA
96001-2461
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-4034
  • Fax: 530-244-1826
Mailing address:
  • Phone: 530-244-4034
  • Fax: 530-244-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC151805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: