Healthcare Provider Details

I. General information

NPI: 1962027516
Provider Name (Legal Business Name): DANNIE JULIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANNIE MILLIS RN

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 KEDZIE AVE
SAN DIEGO CA
92154-2650
US

IV. Provider business mailing address

727 KEDZIE AVE
SAN DIEGO CA
92154-2650
US

V. Phone/Fax

Practice location:
  • Phone: 619-758-5868
  • Fax:
Mailing address:
  • Phone: 619-758-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95038248
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: