Healthcare Provider Details

I. General information

NPI: 1528414166
Provider Name (Legal Business Name): JULIANA LA MADRID BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANA CASTRO-JOUVET

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 3RD AVE
SAN DIEGO CA
92103
US

IV. Provider business mailing address

4309 3RD AVE
SAN DIEGO CA
92103-1407
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-4502
  • Fax:
Mailing address:
  • Phone: 619-876-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: