Provider Demographics
NPI:1952824765
Name:MARR, JULIE A (RD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:MARR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:ASHBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2425 GEARY BLVD RM 5413
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3358
Mailing Address - Country:US
Mailing Address - Phone:415-833-3863
Mailing Address - Fax:
Practice Address - Street 1:2425 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-833-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA932211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA941105628Medicaid