Healthcare Provider Details

I. General information

NPI: 1396107629
Provider Name (Legal Business Name): JULIA BLOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 EVERETT DR STE 400
KYLE TX
78640-6147
US

IV. Provider business mailing address

6210 E HIGHWAY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-295-1333
  • Fax: 512-406-7327
Mailing address:
  • Phone: 512-483-9569
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS0634
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: