Provider Demographics
NPI:1013269240
Name:ZIMLICH, JULIANNE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MICHELLE
Last Name:ZIMLICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1719
Mailing Address - Country:US
Mailing Address - Phone:650-560-0216
Mailing Address - Fax:650-295-0397
Practice Address - Street 1:575 KELLY ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1719
Practice Address - Country:US
Practice Address - Phone:650-560-0216
Practice Address - Fax:650-295-0397
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22370363A00000X
WAPA60299280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant