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NPI Code Detail

MEDICARE: JULIE NIEDENS PA-C

MEDICARE: JULIE NIEDENS 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
1363A00000XPhysician AssistantPA20451CA

General Provider Information

NPI Number : 1558698399
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE NIEDENS PA-C
Provider Business Mailing Address
First Line : 2353 FARRINGTON DR
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1077
Country : US
Telephone Number : 619-368-6586
Fax Number :
Provider Business Practice Location Address
First Line : 1685 E MAIN ST STE 301
Second Line :
City : EL CAJON
State : CA
Zip : 92021-5292
Country : US
Telephone Number : 619-881-4568
Fax Number : 619-442-6398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2009
Last Update Date : 08/27/2010

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Directions to “ JULIE NIEDENS PA-C” Practice Location

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