Provider Demographics
NPI:1275662629
Name:CORREIA, JULIE WALKER (MA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:WALKER
Last Name:CORREIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 S CORNING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1304
Mailing Address - Country:US
Mailing Address - Phone:310-645-7505
Mailing Address - Fax:310-645-7501
Practice Address - Street 1:2690 PACIFIC AVE STE 220
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2659
Practice Address - Country:US
Practice Address - Phone:310-487-1575
Practice Address - Fax:310-645-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU56237600000X
CA2745237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0000560Medicaid
CAAUD56Medicare ID - Type Unspecified