Provider Demographics
NPI:1184664070
Name:BRICE, JULEE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULEE
Middle Name:ANN
Last Name:BRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE # 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:909-651-4300
Mailing Address - Fax:
Practice Address - Street 1:25828 REDLANDS BLVD
Practice Address - Street 2:SUITE 102, 103
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8449
Practice Address - Country:US
Practice Address - Phone:909-806-1598
Practice Address - Fax:909-887-1985
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16596207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA165960Medicare PIN
CAP69001Medicare UPIN