Provider Demographics
NPI:1932243367
Name:JULIE STARK, DO, INC.
Entity Type:Organization
Organization Name:JULIE STARK, DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-706-9700
Mailing Address - Street 1:5731 RIDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4619
Mailing Address - Country:US
Mailing Address - Phone:818-706-9700
Mailing Address - Fax:805-374-1423
Practice Address - Street 1:2125 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2942
Practice Address - Country:US
Practice Address - Phone:805-374-1420
Practice Address - Fax:805-374-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA6747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty