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General NPI Number Information
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NPI Number | 1932243367
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Entity Type | Organization
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Legal Business Name | JULIE STARK, DO, INC.
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2125 E THOUSAND OAKS BLVD SUITE A
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2942
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Country | US
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Telephone | 805-374-1420
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Fax | 805-374-1423
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Provider Business Mailing Address
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Address Line | 5731 RIDGEBROOK DR
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City | AGOURA
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State | CA
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Zip | 91301-4619
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Country | US
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Telephone | 818-706-9700
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Fax | 805-374-1423
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIE RACHEL STARK
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Credential | D.O.
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Telephone | 818-706-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2OA6747
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License Number State | CA
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