Provider Demographics
NPI:1609471085
Name:VIDAL, JULIENNE
Entity Type:Individual
Prefix:
First Name:JULIENNE
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 OWENS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4680
Mailing Address - Country:US
Mailing Address - Phone:805-720-1981
Mailing Address - Fax:
Practice Address - Street 1:155 GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3747
Practice Address - Country:US
Practice Address - Phone:844-764-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician