Provider Demographics
NPI:1124990585
Name:MELLO VAZ, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MELLO VAZ
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 1:2406 BAXTER RD APT 3
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2706
Mailing Address - Country:US
Mailing Address - Phone:765-419-0411
Mailing Address - Fax:800-727-9914
Practice Address - Street 1:1315 E HOFFER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2474
Practice Address - Country:US
Practice Address - Phone:765-419-0411
Practice Address - Fax:800-727-9914
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician