Provider Demographics
NPI:1083780621
Name:GRIFFITH, JULIE A (MD MS, CMT, BCIP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MD MS, CMT, BCIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:LAGUNITAS
Mailing Address - State:CA
Mailing Address - Zip Code:94938-0531
Mailing Address - Country:US
Mailing Address - Phone:415-925-1616
Mailing Address - Fax:415-962-1303
Practice Address - Street 1:7090 SIR FRANCIS DRAKE BLVD # 531
Practice Address - Street 2:
Practice Address - City:LAGUNITAS
Practice Address - State:CA
Practice Address - Zip Code:94938-8904
Practice Address - Country:US
Practice Address - Phone:415-925-1616
Practice Address - Fax:415-962-1303
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG030182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
006830180Medicare UPIN