Provider Demographics
NPI:1417687781
Name:BRUST, JULIA LYNNE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNNE
Last Name:BRUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0941
Mailing Address - Country:US
Mailing Address - Phone:760-994-7048
Mailing Address - Fax:
Practice Address - Street 1:1653 APPALOOSA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5604
Practice Address - Country:US
Practice Address - Phone:760-994-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach