Provider Demographics
NPI:1275607160
Name:SOARES, JULIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:A
Last Name:SOARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 HOLLISTER AVE STE 195
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2465
Mailing Address - Country:US
Mailing Address - Phone:805-967-1359
Mailing Address - Fax:805-683-3319
Practice Address - Street 1:5333 HOLLISTER AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-3309
Practice Address - Country:US
Practice Address - Phone:805-967-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32832174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770143765OtherTAX ID
CAA32832OtherCALIFORNIA LICENSE
CAA32832OtherCALIFORNIA LICENSE