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NPI Code Detail

MEDICARE: MR. JULIA ANN LOGAN

MEDICARE:  MR. JULIA ANN LOGAN
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
1171400000XHealth & Wellness Coach1231107674CA

General Provider Information

NPI Number : 1770302010
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JULIA ANN LOGAN
Provider Business Mailing Address
First Line : 1273 S KIRKMAN RD APT 3172
Second Line :
City : ORLANDO
State : FL
Zip : 32811-2532
Country : US
Telephone Number : 714-907-3228
Fax Number :
Provider Business Practice Location Address
First Line : 1273 S KIRKMAN RD APT 3172
Second Line :
City : ORLANDO
State : FL
Zip : 32811-2532
Country : US
Telephone Number : 714-907-3228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2024
Last Update Date : 10/03/2024

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Directions to “ MR. JULIA ANN LOGAN ” Practice Location

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