Provider Demographics
NPI:1407401128
Name:JULIAN, FIDES (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:FIDES
Middle Name:
Last Name:JULIAN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 STATION VILLAGE LN APT 2001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5586
Mailing Address - Country:US
Mailing Address - Phone:312-863-1131
Mailing Address - Fax:
Practice Address - Street 1:8244 STATION VILLAGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5542
Practice Address - Country:US
Practice Address - Phone:312-863-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18652171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist