Provider Demographics
NPI:1154520708
Name:PHENCO, JULIE ANN HUAT (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE ANN
Middle Name:HUAT
Last Name:PHENCO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:101 PARKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:916-580-3240
Mailing Address - Fax:916-840-7664
Practice Address - Street 1:101 PARKSHORE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:916-580-3240
Practice Address - Fax:916-840-7664
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2024-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1240592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015806Medicaid
WV3810015806Medicaid