Provider Demographics
NPI:1598317554
Name:GROSS, JULIE ANNE (LE)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:GROSS
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31635 BURNHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8013
Mailing Address - Country:US
Mailing Address - Phone:415-786-8872
Mailing Address - Fax:
Practice Address - Street 1:4131 1/2 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5109
Practice Address - Country:US
Practice Address - Phone:415-786-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty