Provider Demographics
NPI:1750823548
Name:JULIANO, MARK ANGELO
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANGELO
Last Name:JULIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300B FM 10825 STE. 101
Mailing Address - Street 2:
Mailing Address - City:PLFUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-9001
Mailing Address - Country:US
Mailing Address - Phone:512-202-3686
Mailing Address - Fax:512-590-7324
Practice Address - Street 1:15300B FM 10825 STE. 101
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-9001
Practice Address - Country:US
Practice Address - Phone:512-202-3686
Practice Address - Fax:512-590-7324
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator