Provider Demographics
NPI:1184785453
Name:DICIANNO, JULIE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:DICIANNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3150 CARLISLE BLVD NE
Mailing Address - Street 2:STE 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1680
Mailing Address - Country:US
Mailing Address - Phone:505-884-3344
Mailing Address - Fax:
Practice Address - Street 1:3150 CARLISLE BLVD NE
Practice Address - Street 2:STE 107
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1682
Practice Address - Country:US
Practice Address - Phone:505-884-3344
Practice Address - Fax:866-790-2292
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM90182208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine