Provider Demographics
NPI:1851930572
Name:FERNENGEL, JULIE ANN (CNIM, REEGT)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:ANN
Last Name:FERNENGEL
Suffix:
Gender:F
Credentials:CNIM, REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20331 IRVINE AVE STE E2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0223
Mailing Address - Country:US
Mailing Address - Phone:614-306-3746
Mailing Address - Fax:
Practice Address - Street 1:20331 IRVINE AVE STE E2
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:614-306-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5341246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic