Provider Demographics
NPI:1174920367
Name:GODLEY, JULIA (NP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GODLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 KEARNY VILLA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1150
Mailing Address - Country:US
Mailing Address - Phone:858-634-5870
Mailing Address - Fax:
Practice Address - Street 1:1706 DESCANSO AVE
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2514
Practice Address - Country:US
Practice Address - Phone:760-280-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21357363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology