Provider Demographics
NPI:1912561689
Name:FRITZ, JULIANA RACHEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:RACHEL
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-1844
Mailing Address - Fax:510-506-7721
Practice Address - Street 1:2850 TELEGRAPH AVE STE 120
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1159
Practice Address - Country:US
Practice Address - Phone:510-204-1844
Practice Address - Fax:510-506-7721
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56708OtherPHYSICIAN ASSISTANT BOARD STATE LICENSE