Healthcare Provider Details

I. General information

NPI: 1578217105
Provider Name (Legal Business Name): JOSE JUAREZ HERNANDEZ NCMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE JUAREZ HERNANDEZ NCMA

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3298
US

IV. Provider business mailing address

101 THE CITY DR S
ORANGE CA
92868-3298
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-3795
  • Fax: 714-509-2145
Mailing address:
  • Phone: 714-456-3795
  • Fax: 714-509-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: