Provider Demographics
NPI:1891736757
Name:BLANK, JULIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:881 ALMA REAL DR
Mailing Address - Street 2:316
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-829-8923
Mailing Address - Fax:424-212-5936
Practice Address - Street 1:881 ALMA REAL DR STE 101
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3792
Practice Address - Country:US
Practice Address - Phone:310-829-8923
Practice Address - Fax:424-212-5936
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14560DOtherMEDICARE PTAN
CAW14560DOtherMEDICARE PTAN
CAH85590Medicare UPIN