Julie Elaine Boulos, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

59287 Issued in CA

Practice address

2180 Garnet Ave Ste 1K
San Diego, CA 92109-3674

Phone

(858) 270-4904

Fax

(858) 270-4275

NPI assigned

Aug 13, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Julie E Hagar Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295222400000",
    "number": "1144452855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 GARNET AVE STE 1K",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093674",
            "telephone_number": "858-270-4904",
            "fax_number": "858-270-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 GARNET AVE STE 1K",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093674",
            "telephone_number": "858-270-4904",
            "fax_number": "858-270-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "JULIE",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-13",
        "last_updated": "2011-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "HAGAR",
            "middle_name": "E",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marc Patrick Boulanger II, DNP, PMHNP-BC
• Meagan Bouldin, RN BSN
• Elizabeth N Boulette, CRNA
• Boulevard Dental Center
• Joseph Boulos, DDS
• Giscard Boulou
• Katelynn Bouma
• Yamina Boundaoui, RN
• Mark Bounthavong, PHARM.D.
• Lauren Bounyavong

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.