Provider Demographics
NPI:1154141380
Name:JULIA-SURIANO, STEPHANIE (QMHA-R)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JULIA-SURIANO
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61007 SE SYDNEY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3760
Mailing Address - Country:US
Mailing Address - Phone:973-477-0939
Mailing Address - Fax:
Practice Address - Street 1:61007 SE SYDNEY HARBOR DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3760
Practice Address - Country:US
Practice Address - Phone:973-477-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach