Provider Demographics
NPI:1225020571
Name:CHACKO, JULIE A (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5575 HOLLISTER AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3825
Mailing Address - Country:US
Mailing Address - Phone:805-964-3838
Mailing Address - Fax:805-964-6946
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-687-7719
Practice Address - Fax:805-682-2971
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2009-11-23
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Provider Licenses
StateLicense IDTaxonomies
CAA69285208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225020571Medicaid
CA1225020571Medicaid
CA6282650001Medicare NSC
CAA69285Medicare PIN