Provider Demographics
NPI:1629389176
Name:ASTALIS, JULIANA MARGARETA (RPH)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:MARGARETA
Last Name:ASTALIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N LUCERNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3722
Mailing Address - Country:US
Mailing Address - Phone:323-465-5924
Mailing Address - Fax:
Practice Address - Street 1:6130 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-6424
Practice Address - Country:US
Practice Address - Phone:323-467-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist