Provider Demographics
NPI:1447070321
Name:FUKUCHI, JULIAN
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:FUKUCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 LA MONTE RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3626
Mailing Address - Country:US
Mailing Address - Phone:833-922-2669
Mailing Address - Fax:
Practice Address - Street 1:8022 LA MONTE RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3626
Practice Address - Country:US
Practice Address - Phone:833-922-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician