Provider Demographics
NPI:1255859047
Name:HEREDIA, JULIO
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SANSOME ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3713
Mailing Address - Country:US
Mailing Address - Phone:415-819-8148
Mailing Address - Fax:510-922-8737
Practice Address - Street 1:180 SANSOME STREET, 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-819-8148
Practice Address - Fax:510-922-8737
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA007462171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter