Provider Demographics
NPI:1851132930
Name:TAFT, JULIA KRISTINE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KRISTINE
Last Name:TAFT
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 1:4464 CASTELAR ST APT 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1482
Mailing Address - Country:US
Mailing Address - Phone:253-310-3329
Mailing Address - Fax:
Practice Address - Street 1:5555 RESERVOIR DR STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5136
Practice Address - Country:US
Practice Address - Phone:619-363-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1588967236103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral