Provider Demographics
NPI:1790777506
Name:FALLON, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:FALLON
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 1:295 POSADA LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4055
Mailing Address - Country:US
Mailing Address - Phone:805-434-9900
Mailing Address - Fax:805-434-9933
Practice Address - Street 1:295 POSADA LN
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4055
Practice Address - Country:US
Practice Address - Phone:805-434-9900
Practice Address - Fax:805-434-9933
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA049268OtherBLUE SHIELD
CAA049268OtherBLUE CROSS
CA00A492680Medicaid
BF2169274OtherDEA
BF2169274OtherDEA
CAA49268Medicare PIN