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General NPI Number Information
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NPI Number | 1497614358
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Entity Type | Individual
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Provider Name | JULIAN MOONLIGHTT
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Gender |
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 111 MODESTO AVE
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City | MODESTO
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State | CA
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Zip | 95354-0414
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Country | US
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Telephone | 209-408-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 H ST
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City | MODESTO
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State | CA
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Zip | 95354-2443
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Country | US
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Telephone | 209-681-6164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 1639965189
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License Number State | CA
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