MEDICARE: JULIA RAE MIDDLETON PA-C

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	363A00000X	Physician Assistant	PA737	ID
2	363A00000X	Physician Assistant	PA22232	CA

General Provider Information

NPI Number	:	1215113741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA RAE MIDDLETON PA-C

Provider Business Mailing Address
First Line	:	24035 NEWHALL RANCH RD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5702
Country	:	US
Telephone Number	:	661-291-3444
Fax Number	:	661-291-3456

Provider Business Practice Location Address
First Line	:	24035 NEWHALL RANCH RD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5702
Country	:	US
Telephone Number	:	661-291-3444
Fax Number	:	661-291-3456

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	04/02/2013

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