Basic Information
| Provider Information | |||||||||
| NPI: | 1356637300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORERO | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | FREDERICKSON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3065 W SOUTHLAKE BLVD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173805911 | ||||||||
| FaxNumber: | 8173805911 | ||||||||
| Practice Location | |||||||||
| Address1: | LARKIN COMMUNITY HOSPITAL | ||||||||
| Address2: | 7031 SW 62 AVENUE | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052847761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | OS 12140 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.