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General NPI Number Information
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NPI Number | 1336754035
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Entity Type | Organization
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Legal Business Name | JULIANA S. DALE DO PA
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 250 2ND ST E STE 3B
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City | BRADENTON
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State | FL
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Zip | 34208-1027
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Country | US
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Telephone | 561-909-7452
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Fax |
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Provider Business Mailing Address
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Address Line | 250 2ND ST E STE 3B
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City | BRADENTON
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State | FL
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Zip | 34208-1027
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Country | US
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Telephone | 941-253-0030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIANA SANTIAGO DALE
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Credential | DO
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Telephone | 941-253-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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