Active NPI
Julie S Fallon, MD
- Pediatrics Physician
- Fountain Valley, CA
National Provider Identifier
1891785234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A78180
- Practice address
- 11420 Warner Ave
Fountain Valley, CA 92708-2529 - Phone
- (714) 549-1300
- Fax
- (714) 433-3100
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A78180 | CA | Primary |
Addresses
Primary practice location
11420 Warner Ave
Fountain Valley, CA 92708-2529
Mailing address
2742 Dow Ave
Tustin, CA 92780-7242
Phone (714) 665-1600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A781800 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A78180 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorialcare Medical Foundation | Pediatrics | Current | Accepting new patients |
Locations
722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300
11420 Warner Ave
Fountain Vly, CA 92708
Phone (714) 549-1300
17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592
2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301529600000",
"number": "1891785234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2742 DOW AVE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927807242",
"telephone_number": "714-665-1600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11420 WARNER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082529",
"telephone_number": "714-549-1300",
"fax_number": "714-433-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALLON",
"first_name": "JULIE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2011-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A78180",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A781800",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.