Provider Demographics
NPI:1235116955
Name:DAVISON, JULIA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH
Last Name:DAVISON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELIZABETH
Other - Last Name:JACOBSOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 ELLA ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4166
Mailing Address - Country:US
Mailing Address - Phone:805-541-6000
Mailing Address - Fax:805-541-6001
Practice Address - Street 1:1304 ELLA ST STE B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4166
Practice Address - Country:US
Practice Address - Phone:805-541-6000
Practice Address - Fax:805-541-6001
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA197363A00000X
CA51448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES07132Medicare UPIN