Provider Demographics
NPI:1922152438
Name:MARTIN, JULIA DEMETRIOUS (494412)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:DEMETRIOUS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:494412
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:DEMETRIOUS
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15313 RANCHO POLERMO RD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4569
Mailing Address - Country:US
Mailing Address - Phone:562-408-0903
Mailing Address - Fax:
Practice Address - Street 1:550 S VERMONT AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-639-6777
Practice Address - Fax:213-637-0790
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494412163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health