Provider Demographics
NPI:1750858882
Name:DEJULIO, MONICA (FNP-BC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DEJULIO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:C
Other - Last Name:BOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2498 SAWGRASS ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 RAINIER AVE S # A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3046
Practice Address - Country:US
Practice Address - Phone:206-686-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-68959106S00000X
CA2023006900363LF0000X
WAAP61461749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician