Provider Demographics
NPI:1902618853
Name:FUJITA, JULIE HANLON (CAMTC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:HANLON
Last Name:FUJITA
Suffix:
Gender:F
Credentials:CAMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CORTE SUR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5926
Mailing Address - Country:US
Mailing Address - Phone:860-485-4778
Mailing Address - Fax:
Practice Address - Street 1:7075 REDWOOD BLVD STE H
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4136
Practice Address - Country:US
Practice Address - Phone:860-485-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist