Provider Demographics
NPI:1447551569
Name:OVANDO, JULIO JR (CCP)
Entity type:Individual
Prefix:MR
First Name:JULIO
Middle Name:
Last Name:OVANDO
Suffix:JR
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3174 DENVER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6141
Mailing Address - Country:US
Mailing Address - Phone:530-351-1952
Mailing Address - Fax:
Practice Address - Street 1:3174 DENVER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6141
Practice Address - Country:US
Practice Address - Phone:530-351-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830061242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist