Provider Demographics
NPI:1225067333
Name:HORNBECK, JULIA B (MS, RD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:B
Last Name:HORNBECK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALIFORNIA KIDNEY MEDICAL GROUP, INC
Mailing Address - Street 2:P.O. BOX 940838
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:93094
Mailing Address - Country:US
Mailing Address - Phone:805-496-1266
Mailing Address - Fax:805-496-6785
Practice Address - Street 1:CALIFORNIA KIDNEY MEDICAL GROUP, INC.
Practice Address - Street 2:50 MORELAND RD.
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-433-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL916256133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT916256AMedicare ID - Type UnspecifiedPROVIDER NUMBER