Provider Demographics
NPI:1457066763
Name:DEITCH, JULIE ROSE (VN130571)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ROSE
Last Name:DEITCH
Suffix:
Gender:F
Credentials:VN130571
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E. 120TH ST.
Mailing Address - Street 2:INTERNS AND RESIDENCE BUILDING, ROOM 3-220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-4598
Mailing Address - Country:US
Mailing Address - Phone:424-338-2200
Mailing Address - Fax:310-764-5274
Practice Address - Street 1:1670 E 120TH ST
Practice Address - Street 2:INTERNS AND RESIDENTS BUILDING, RM 3-220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-338-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN130571164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse