Healthcare Provider Details

I. General information

NPI: 1295310175
Provider Name (Legal Business Name): GABRIEL JUAREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD STE 111
GLENDALE CA
91208-1449
US

IV. Provider business mailing address

7652 WENTWORTH ST
TUJUNGA CA
91042-1637
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-2223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: