Provider Demographics
NPI:1891381687
Name:DIEMERT, JULIANA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:DIEMERT
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 1:3365 MELODYE CT
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-9458
Mailing Address - Country:US
Mailing Address - Phone:218-850-7437
Mailing Address - Fax:
Practice Address - Street 1:1145 SIBLEY ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3222
Practice Address - Country:US
Practice Address - Phone:916-292-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY7952071106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician