Healthcare Provider Details

I. General information

NPI: 1962798363
Provider Name (Legal Business Name): JULIA ELISA BARILLAS CERRITOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MINEOLA BLVD FL 2
MINEOLA NY
11501-4089
US

IV. Provider business mailing address

101 MINEOLA BLVD FL 2
MINEOLA NY
11501-4089
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3511
  • Fax: 516-663-3070
Mailing address:
  • Phone: 516-663-3511
  • Fax: 516-663-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number003737
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number272839
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1962798363
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: