Provider Demographics
NPI:1467415570
Name:CLAVERIA, JULIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:CLAVERIA
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 1:23792 ROCKFIELD BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2868
Mailing Address - Country:US
Mailing Address - Phone:949-951-8391
Mailing Address - Fax:949-951-1831
Practice Address - Street 1:23792 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2868
Practice Address - Country:US
Practice Address - Phone:949-951-8391
Practice Address - Fax:949-951-1831
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF34450Medicare UPIN
CAG69550Medicare ID - Type Unspecified