Provider Demographics
NPI:1629150396
Name:HODGE, JULIE A, (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A,
Last Name:HODGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1440 N HARBOR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4116
Mailing Address - Country:US
Mailing Address - Phone:714-526-7546
Mailing Address - Fax:714-526-7547
Practice Address - Street 1:1440 N HARBOR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4116
Practice Address - Country:US
Practice Address - Phone:714-526-7546
Practice Address - Fax:714-526-7547
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48399207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE82764Medicare UPIN
CAW17996Medicare ID - Type Unspecified