Provider Demographics
NPI:1760639355
Name:WILLARD, JULIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WASHINGTON ST.
Mailing Address - Street 2:SUTIE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:858-278-3647
Mailing Address - Fax:253-320-2092
Practice Address - Street 1:770 WASHINGTON ST.
Practice Address - Street 2:SUTIE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:858-278-3647
Practice Address - Fax:253-320-2092
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine