| Doctor Name: | DR. JULIE DICIANNO |
| NPI Number: | 1184785453 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 90182 |
| Business Practice Address: | 7510 Montgomery Blvd Ne Suite 203 Albuquerque, NM - 871091500 |
| Business Phone Number: | 5058555545 |
| Business Fax Number: | 5058555541 |
| Mailing Address: | 7510 Montgomery Blvd Ne, Suite 203 ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871091500 |
| Phone Number: | 5058555545 |
| Fax Number: | 5058555541 |
| NPI Enumeration Date: | 12/12/2006 |
| NPI Last Update Date: | 02/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 90182 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |