Basic Information
| Provider Information | |||||||||
| NPI: | 1225067333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNBECK | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MS, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALIFORNIA KIDNEY MEDICAL GROUP, INC | ||||||||
| Address2: | P.O. BOX 940838 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054961266 | ||||||||
| FaxNumber: | 8054966785 | ||||||||
| Practice Location | |||||||||
| Address1: | CALIFORNIA KIDNEY MEDICAL GROUP, INC. | ||||||||
| Address2: | 50 MORELAND RD. | ||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054337777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | 916256 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.