Basic Information
| Provider Information | |||||||||
| NPI: | 1083801393 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULIE A HODGE MD A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 N HARBOR BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928354116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145267546 | ||||||||
| FaxNumber: | 7145267547 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 N HARBOR BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928354116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145267546 | ||||||||
| FaxNumber: | 7145267547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | HODGE | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7145267546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | A48399 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No ID Information.