Provider Demographics
NPI:1881672798
Name:SIERRA, JULIE ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ROSE
Last Name:SIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:PISKUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:292 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2720
Mailing Address - Country:US
Mailing Address - Phone:619-872-8775
Mailing Address - Fax:
Practice Address - Street 1:292 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2720
Practice Address - Country:US
Practice Address - Phone:619-872-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15414207R00000X
IL036113683207R00000X
CAA117850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI637572-02Medicaid
HI0000289553OtherHMSA BILLING NUMBER
HII35021Medicare UPIN
HICN866ZMedicare PIN