Healthcare Provider Details

I. General information

NPI: 1720606197
Provider Name (Legal Business Name): JULIA ANTOINETTE LORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 NORTHROP DR APT 56
RIVERSIDE CA
92508-5004
US

IV. Provider business mailing address

7450 NORTHROP DR APT 56
RIVERSIDE CA
92508-5004
US

V. Phone/Fax

Practice location:
  • Phone: 951-422-2909
  • Fax:
Mailing address:
  • Phone: 951-422-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: