Provider Demographics
NPI:1467677872
Name:BIESIADA, JULE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULE
Middle Name:
Last Name:BIESIADA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 GRANITE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0675
Mailing Address - Country:US
Mailing Address - Phone:209-383-2835
Mailing Address - Fax:
Practice Address - Street 1:414 W 21ST ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3718
Practice Address - Country:US
Practice Address - Phone:209-384-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17648103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY17648Medicare UPIN