Provider Demographics
NPI:1578953097
Name:DEEN, JULIA (R D)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DEEN
Suffix:
Gender:F
Credentials:R D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16037 W WADE LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9773
Mailing Address - Country:US
Mailing Address - Phone:719-332-7104
Mailing Address - Fax:
Practice Address - Street 1:9165 W THUNDERBIRD RD STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-285-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
1066916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered