Healthcare Provider Details

I. General information

NPI: 1528476256
Provider Name (Legal Business Name): JULIE CHRISCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 06/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 NORTHSIDE DR SUITE 100
SAN DIEGO CA
92108-2709
US

IV. Provider business mailing address

2365 NORTHSIDE DR SUITE 100
SAN DIEGO CA
92108-2709
US

V. Phone/Fax

Practice location:
  • Phone: 855-848-5433
  • Fax: 888-971-4283
Mailing address:
  • Phone: 855-848-5433
  • Fax: 888-971-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95000961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: