Provider Demographics
NPI:1043909294
Name:FITT, JULIE (PMH,NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FITT
Suffix:
Gender:F
Credentials:PMH,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N GLENDALE AVE
Mailing Address - Street 2:SUITE B #220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2606
Practice Address - Country:US
Practice Address - Phone:415-412-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health