Provider Demographics
NPI:1114787470
Name:STEWART, JULY REVERIE (LE)
Entity Type:Individual
Prefix:
First Name:JULY
Middle Name:REVERIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WALTER COLTON DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4230
Mailing Address - Country:US
Mailing Address - Phone:831-455-5037
Mailing Address - Fax:
Practice Address - Street 1:222 17TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3325
Practice Address - Country:US
Practice Address - Phone:831-455-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty