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General NPI Number Information
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NPI Number | 1518978196
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Entity Type | Organization
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Legal Business Name | JULIA B DUREG
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 2911 BEVERLY BLVD STE 102
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City | LOS ANGELES
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State | CA
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Zip | 90057-1025
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Country | US
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Telephone | 213-480-6588
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Fax | 213-480-6582
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Provider Business Mailing Address
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Address Line | 2911 BEVERLY BLVD STE 102
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City | LOS ANGELES
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State | CA
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Zip | 90057-1025
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Country | US
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Telephone | 213-480-6588
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Fax | 213-480-6582
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Authorized Official
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Title or Position | OWNER
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Name | JULIA ONGGOSUWARNO
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Credential |
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Telephone | 213-480-6588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY46246
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License Number State | CA
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