Provider Demographics
NPI:1245748672
Name:RESTIS, JULIE SOTHARY VAN (MPH, RN, FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SOTHARY VAN
Last Name:RESTIS
Suffix:
Gender:F
Credentials:MPH, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 LOUISIANA ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2752
Mailing Address - Country:US
Mailing Address - Phone:619-948-7761
Mailing Address - Fax:
Practice Address - Street 1:3930 LOUISIANA ST APT 8
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2752
Practice Address - Country:US
Practice Address - Phone:619-948-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily