Provider Demographics
NPI:1609400977
Name:SMITH, JULIE (LM, CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:YULI
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM, IBCLC
Mailing Address - Street 1:30203 CUPENO LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2520
Mailing Address - Country:US
Mailing Address - Phone:760-968-6731
Mailing Address - Fax:
Practice Address - Street 1:30203 CUPENO LN
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2520
Practice Address - Country:US
Practice Address - Phone:760-968-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM667176B00000X
CA667176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA667OtherMEDICAL BOARD OF CALIFORNIA/IBCLE
CAL-308557OtherIBCLE