Provider Demographics
NPI:1689718017
Name:STARK, JULIE RACHEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RACHEL
Last Name:STARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 RIDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4619
Mailing Address - Country:US
Mailing Address - Phone:818-706-9700
Mailing Address - Fax:805-374-1423
Practice Address - Street 1:2125 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2942
Practice Address - Country:US
Practice Address - Phone:805-374-1420
Practice Address - Fax:805-374-1423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA6747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine