Provider Demographics
NPI:1396712188
Name:DI JULIO, THOMAS P (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:DI JULIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15160
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0160
Mailing Address - Country:US
Mailing Address - Phone:562-425-3229
Mailing Address - Fax:562-421-8114
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:#208
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2124
Practice Address - Country:US
Practice Address - Phone:562-498-1182
Practice Address - Fax:562-985-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
343789000OtherUS DEPT OF LABOR (ASC)
CA00G30870Medicaid
CA130001756OtherRAILROAD MEDICARE
CA00G308970OtherBLUE SHIELD
CAG30897Medicare ID - Type Unspecified
343789000OtherUS DEPT OF LABOR (ASC)