Provider Demographics
NPI:1518202621
Name:LUTY, JULITA TEODOSIO (NP)
Entity Type:Individual
Prefix:MS
First Name:JULITA
Middle Name:TEODOSIO
Last Name:LUTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34449 BRIDGEWATER PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2304
Mailing Address - Country:US
Mailing Address - Phone:510-825-6726
Mailing Address - Fax:
Practice Address - Street 1:151 W MISSION ST
Practice Address - Street 2:ROOM 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1713
Practice Address - Country:US
Practice Address - Phone:408-277-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN320968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner