Healthcare Provider Details

I. General information

NPI: 1265463905
Provider Name (Legal Business Name): JUAN C CIFUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10938 VANOWEN ST
NORTH HOLLYWOOD CA
91605-6407
US

IV. Provider business mailing address

10938 VANOWEN ST
NORTH HOLLYWOOD CA
91605-6407
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-2461
  • Fax: 818-760-1105
Mailing address:
  • Phone: 818-760-2461
  • Fax: 818-760-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: