Provider Demographics
NPI:1194102764
Name:JULIE GRADOS WELLNESS
Entity type:Organization
Organization Name:JULIE GRADOS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADOS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-566-7423
Mailing Address - Street 1:13101 W WASHINGTON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5176
Mailing Address - Country:US
Mailing Address - Phone:310-566-7423
Mailing Address - Fax:
Practice Address - Street 1:13101 W WASHINGTON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5176
Practice Address - Country:US
Practice Address - Phone:310-566-7423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-02
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty