Basic Information
| Provider Information | |||||||||
| NPI: | 1790070159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4660 PALM AVE | ||||||||
| Address2: | BLDG 4, 2ND FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921548404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774960450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4660 PALM AVE | ||||||||
| Address2: | BLDG 4, 2ND FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921548404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199527804 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A123253 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.