Provider Demographics
NPI:1336555978
Name:FAST, JULIA SOPHIA (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:SOPHIA
Last Name:FAST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:SOPHIA
Other - Last Name:SKOCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:182 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1649
Mailing Address - Country:US
Mailing Address - Phone:719-346-9481
Mailing Address - Fax:719-346-9485
Practice Address - Street 1:1411 S POTOMAC ST STE 300
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4539
Practice Address - Country:US
Practice Address - Phone:303-531-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0065325207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine