Provider Demographics
NPI:1467778456
Name:SHRIVASTAVA, JULIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANN
Last Name:SHRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3082
Mailing Address - Country:US
Mailing Address - Phone:858-793-2727
Mailing Address - Fax:
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3082
Practice Address - Country:US
Practice Address - Phone:858-793-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33085207Q00000X
MN62453207Q00000X
IL036.143937207Q00000X
CAA125301207Q00000X
WI67429-20207Q00000X
VA0101261770207Q00000X
MO2017016675207Q00000X
UT10387259-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine