MEDICARE: GABRIEL JUAREZ JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1295310175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JUAREZ JR.

Provider Business Mailing Address
First Line	:	7652 WENTWORTH ST
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-1637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD STE 111
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1449
Country	:	US
Telephone Number	:	818-952-2223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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