Provider Demographics
NPI:1013136423
Name:DUTTON, JULIE (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DUTTON
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-977-4639
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:4855 ATHERTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1026
Practice Address - Country:US
Practice Address - Phone:408-963-2400
Practice Address - Fax:408-963-2472
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA455229363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ702ZMedicare PIN