Healthcare Provider Details

I. General information

NPI: 1689718017
Provider Name (Legal Business Name): JULIE RACHEL STARK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E THOUSAND OAKS BLVD SUITE A
THOUSAND OAKS CA
91362-2942
US

IV. Provider business mailing address

5731 RIDGEBROOK DR
AGOURA CA
91301-4619
US

V. Phone/Fax

Practice location:
  • Phone: 805-374-1420
  • Fax: 805-374-1423
Mailing address:
  • Phone: 818-706-9700
  • Fax: 805-374-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2OA6747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: