Provider Demographics
NPI:1275709594
Name:MATHEWSON, JULIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SCHUBERT CT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92617-4050
Mailing Address - Country:US
Mailing Address - Phone:949-502-5438
Mailing Address - Fax:
Practice Address - Street 1:4521 CAMPUS DR
Practice Address - Street 2:#367
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2621
Practice Address - Country:US
Practice Address - Phone:949-502-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE98814Medicare UPIN