Provider Demographics
NPI:1588786933
Name:THOMAS P. DI JULIO, M.D., INC
Entity type:Organization
Organization Name:THOMAS P. DI JULIO, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DI JULIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-498-1182
Mailing Address - Street 1:1703 TERMINO AVE
Mailing Address - Street 2:#208
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2124
Mailing Address - Country:US
Mailing Address - Phone:562-498-1182
Mailing Address - Fax:562-985-0522
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:#208
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2124
Practice Address - Country:US
Practice Address - Phone:562-498-1182
Practice Address - Fax:562-985-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G308970Medicaid
CA00G308970Medicaid
CA00G308970Medicaid