Provider Demographics
NPI:1528328283
Name:ROSE, JULIE LAURA (LAC, DIPL, MSTCM)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LAURA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC, DIPL, MSTCM
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:LAURA
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, DIPL, MSTCM
Mailing Address - Street 1:PO BOX 2813
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-2813
Mailing Address - Country:US
Mailing Address - Phone:510-251-2287
Mailing Address - Fax:
Practice Address - Street 1:19935 PRICE AVE # 3
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3338
Practice Address - Country:US
Practice Address - Phone:510-251-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist