Healthcare Provider Details

I. General information

NPI: 1457705444
Provider Name (Legal Business Name): JULIA CARRIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 04/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DAVIS GROVE CIR STE 103
CARY NC
27519-2581
US

IV. Provider business mailing address

204 DAVIS GROVE CIR STE 103
CARY NC
27519-2581
US

V. Phone/Fax

Practice location:
  • Phone: 919-436-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004753
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: