Provider Demographics
NPI:1619637220
Name:HALTON, JULIAN (PHC L2, PN1)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:HALTON
Suffix:
Gender:M
Credentials:PHC L2, PN1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 HAINES ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4313
Mailing Address - Country:US
Mailing Address - Phone:857-320-1578
Mailing Address - Fax:
Practice Address - Street 1:4451 HAINES ST APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4313
Practice Address - Country:US
Practice Address - Phone:857-320-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-334-9847