Provider Demographics
NPI:1063127272
Name:PIZARRO HENRY, JULYSSA (C53395)
Entity type:Individual
Prefix:MRS
First Name:JULYSSA
Middle Name:
Last Name:PIZARRO HENRY
Suffix:
Gender:F
Credentials:C53395
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 AZTEC CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5412
Mailing Address - Country:US
Mailing Address - Phone:939-732-1202
Mailing Address - Fax:
Practice Address - Street 1:2200 SILAS CREEK PKWY STE 1A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5000
Practice Address - Country:US
Practice Address - Phone:336-760-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC53395224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter