MEDICARE: JULY REVERIE STEWART LE

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	174400000X	Specialist	9887	CA

General Provider Information

NPI Number	:	1114787470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULY REVERIE STEWART LE

Provider Business Mailing Address
First Line	:	901 H ST STE 120
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1817
Country	:	US
Telephone Number	:	916-426-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 17TH ST
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-3325
Country	:	US
Telephone Number	:	831-455-5037
Fax Number	:

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

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	06/06/2026

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