Provider Demographics
NPI:1053063958
Name:AGRUSA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:AGRUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11088 52ND AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9286
Mailing Address - Country:US
Mailing Address - Phone:248-904-9126
Mailing Address - Fax:
Practice Address - Street 1:11088 52ND AVE APT 10
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9286
Practice Address - Country:US
Practice Address - Phone:248-904-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other