Provider Demographics
NPI:1932282498
Name:CRAWFORD, JULIA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:DIANE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:D
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2427
Practice Address - Country:US
Practice Address - Phone:831-888-9410
Practice Address - Fax:831-477-7795
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG145227207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI491407-02Medicaid
HI0000219816OtherHMSA BILLING NUMBER
HIH52451Medicare PIN
HI491407-02Medicaid