Provider Demographics
NPI:1962027516
Name:JULIO, DANNIE
Entity Type:Individual
Prefix:
First Name:DANNIE
Middle Name:
Last Name:JULIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANNIE
Other - Middle Name:
Other - Last Name:MILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:727 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2650
Mailing Address - Country:US
Mailing Address - Phone:619-758-5868
Mailing Address - Fax:
Practice Address - Street 1:727 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2650
Practice Address - Country:US
Practice Address - Phone:619-758-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95038248163WM0102X
CA95021146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95038248OtherRN