Healthcare Provider Details

I. General information

NPI: 1841931102
Provider Name (Legal Business Name): RAMON JAUREGUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

6549 W ELLIS DR
LAVEEN AZ
85339-9617
US

V. Phone/Fax

Practice location:
  • Phone: 612-747-2406
  • Fax:
Mailing address:
  • Phone: 602-772-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: