Healthcare Provider Details

I. General information

NPI: 1154851087
Provider Name (Legal Business Name): JULIAN DEWEES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

IV. Provider business mailing address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

V. Phone/Fax

Practice location:
  • Phone: 831-600-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number254616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: