Provider Demographics
NPI:1568880847
Name:STARCEVICH, JULIANA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:STARCEVICH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7607
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:
Practice Address - Street 1:4411 THE 25 WAY NE STE 150
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5888
Practice Address - Country:US
Practice Address - Phone:800-841-4236
Practice Address - Fax:706-653-1230
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-05452085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77252306Medicaid