MEDICARE: JULIE DUTTON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	455229	CA

General Provider Information

NPI Number	:	1013136423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE DUTTON NP

Provider Business Mailing Address
First Line	:	12900 PARK PLAZA DR STE 150
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-9329
Country	:	US
Telephone Number	:	562-977-4639
Fax Number	:	562-741-4479

Provider Business Practice Location Address
First Line	:	4855 ATHERTON AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1026
Country	:	US
Telephone Number	:	408-963-2400
Fax Number	:	408-963-2472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/30/2019

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