Healthcare Provider Details

I. General information

NPI: 1235134107
Provider Name (Legal Business Name): EFREN NATHAN JUAREZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W VALLEY BLVD STE 76
ALHAMBRA CA
91803-3243
US

IV. Provider business mailing address

701 W VALLEY BLVD STE 76
ALHAMBRA CA
91803-3243
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-9075
  • Fax: 626-289-9076
Mailing address:
  • Phone: 626-289-9075
  • Fax: 626-289-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: