Provider Demographics
NPI:1083327902
Name:BOHIGIAN, JULIANNA ROSE
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:ROSE
Last Name:BOHIGIAN
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 1:2447 PACIFIC COAST HWY STE 235
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2714
Mailing Address - Country:US
Mailing Address - Phone:424-453-8862
Mailing Address - Fax:833-232-9769
Practice Address - Street 1:2447 PACIFIC COAST HWY STE 235
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2714
Practice Address - Country:US
Practice Address - Phone:424-453-8862
Practice Address - Fax:833-232-9769
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86209887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered