Provider Demographics
NPI:1235444068
Name:KALTGRAD, JULIE ELANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELANA
Last Name:KALTGRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ELANA
Other - Last Name:NISSIMOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6340 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6340 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2102
Practice Address - Country:US
Practice Address - Phone:949-559-6500
Practice Address - Fax:949-559-6510
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice