Healthcare Provider Details

I. General information

NPI: 1336039148
Provider Name (Legal Business Name): JULIE SALLOUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PALOS VERDES BLVD APT 202
REDONDO BEACH CA
90277-6381
US

IV. Provider business mailing address

319 PALOS VERDES BLVD APT 202
REDONDO BEACH CA
90277-6381
US

V. Phone/Fax

Practice location:
  • Phone: 617-413-9317
  • Fax:
Mailing address:
  • Phone: 617-413-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: