Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301088308 | MI |
N | 208600000X | Surgeon | 4301088308 | MI |
Y | 2086S0102X | Surgical Critical Care | A128857 | CA |
NPI | 1346465168 |
---|---|
Provider Name | Dr. Julie Elizabeth Dierksheide |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 18/09/2020 |