1164059812 NPI number — JULIA SHELTON BRATIC

Table of content: JULIA SHELTON BRATIC (NPI 1164059812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164059812 NPI number — JULIA SHELTON BRATIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRATIC
Provider First Name:
JULIA
Provider Middle Name:
SHELTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164059812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3362 DEL MONTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77019-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-410-5659
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 WELCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-497-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  U5078 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)