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NPI Code Detail

MEDICARE: JULIE MARIE SHRYOCK ELIAS P.A.

MEDICARE: JULIE MARIE SHRYOCK ELIAS P.A.
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
1363A00000XPhysician Assistant004400MI

General Provider Information

NPI Number : 1194768663
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE MARIE SHRYOCK ELIAS P.A.
Provider Business Mailing Address
First Line : 7053 SITIO FRONTERA
Second Line :
City : CARLSBAD
State : CA
Zip : 92009-2045
Country : US
Telephone Number : 760-815-7560
Fax Number :
Provider Business Practice Location Address
First Line : 36485 INLAND VALLEY DR
Second Line :
City : WILDOMAR
State : CA
Zip : 92595-9681
Country : US
Telephone Number : 951-304-7187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 08/19/2014

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