Healthcare Provider Details

I. General information

NPI: 1235878034
Provider Name (Legal Business Name): JULIE LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CIVIC CENTER DR STE D
VISTA CA
92084-6169
US

IV. Provider business mailing address

1221 W VISTA WAY
VISTA CA
92083-6227
US

V. Phone/Fax

Practice location:
  • Phone: 760-691-9622
  • Fax:
Mailing address:
  • Phone: 760-691-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: