Provider Demographics
NPI:1396428215
Name:DUTRA, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DUTRA
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 1:4625 MOUNTAIN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1450
Mailing Address - Country:US
Mailing Address - Phone:530-246-7172
Mailing Address - Fax:
Practice Address - Street 1:389 WOODCLIFF DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2902
Practice Address - Country:US
Practice Address - Phone:530-524-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator