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NPI Code Detail

MEDICARE: JULIANNE VAUGHN WOODSIDE

MEDICARE: JULIANNE VAUGHN WOODSIDE
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
1208100000XPhysical Medicine & Rehabilitation PhysicianPT1530CA

General Provider Information

NPI Number : 1902496011
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIANNE VAUGHN WOODSIDE
Provider Business Mailing Address
First Line : 3217 COLORADO PL
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-2232
Country : US
Telephone Number : 714-322-9181
Fax Number :
Provider Business Practice Location Address
First Line : 3217 COLORADO PL
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-2232
Country : US
Telephone Number : 714-322-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2021
Last Update Date : 01/22/2021

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Directions to “ JULIANNE VAUGHN WOODSIDE ” Practice Location

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