Basic Information
| Provider Information | |||||||||
| NPI: | 1104354778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARTUNDUAGA | ||||||||
| FirstName: | JULIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LEHIGH AVE STE 105 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157078496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E LEHIGH AVE BLDG SUIT105 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191251012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157078496 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 10/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | OT017964 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.