Provider Demographics
NPI:1750987855
Name:LEWALLEN, JULINA CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:JULINA
Middle Name:CHRISTINE
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5938 RIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3258
Mailing Address - Country:US
Mailing Address - Phone:909-342-8304
Mailing Address - Fax:
Practice Address - Street 1:9471 HAVEN AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5818
Practice Address - Country:US
Practice Address - Phone:909-474-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant