Healthcare Provider Details

I. General information

NPI: 1336350586
Provider Name (Legal Business Name): JULIET TUBAT SRIRAT RN , BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST SUITE 550
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

581 S GILBUCK DR
ANAHEIM CA
92802-1319
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-4707
  • Fax:
Mailing address:
  • Phone: 714-778-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number637005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: