Provider Demographics
NPI:1811661093
Name:SANTA MARIA, JULIAN VILLAROSA
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:VILLAROSA
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2413
Mailing Address - Country:US
Mailing Address - Phone:201-647-5172
Mailing Address - Fax:
Practice Address - Street 1:31 SUNSET RD
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2413
Practice Address - Country:US
Practice Address - Phone:201-647-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22614700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered