Provider Demographics
NPI:1710179882
Name:ZELADA, JULIETTE M (MD)
Entity type:Individual
Prefix:DR
First Name:JULIETTE
Middle Name:M
Last Name:ZELADA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1510 SAN PABLO STREET
Mailing Address - Street 2:SUITE 514
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5324
Mailing Address - Country:US
Mailing Address - Phone:323-442-5910
Mailing Address - Fax:323-442-6798
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-225-7346
Practice Address - Fax:907-228-8325
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2024-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA88046208600000X
AK207479208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A880460OtherBLUE SHIELD PROVIDER NUMBER
CAAU733ZMedicare PIN