Healthcare Provider Details

I. General information

NPI: 1316423528
Provider Name (Legal Business Name): ANGELICA JUAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 SANTA FE AVE
LONG BEACH CA
90810-3547
US

IV. Provider business mailing address

2125 SANTA FE AVE
LONG BEACH CA
90810-3547
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-4859
  • Fax: 562-432-9590
Mailing address:
  • Phone: 562-264-4859
  • Fax: 562-432-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPTL4512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179692
License Number StateCA
# 3
Primary TaxonomyN
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: