Healthcare Provider Details

I. General information

NPI: 1073982153
Provider Name (Legal Business Name): JULIA RIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 4TH AVE # 2
SAN DIEGO CA
92103-6206
US

IV. Provider business mailing address

10717 CAMINO RUIZ SUITE 207
SAN DIEGO CA
92126-2360
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-6067
  • Fax:
Mailing address:
  • Phone: 858-695-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: