Healthcare Provider Details

I. General information

NPI: 1194094433
Provider Name (Legal Business Name): JUVELYN P ENCABO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 ROCKLIN CT
SAN JOSE CA
95131-3019
US

IV. Provider business mailing address

1419 ROCKLIN CT
SAN JOSE CA
95131-3019
US

V. Phone/Fax

Practice location:
  • Phone: 732-614-7396
  • Fax:
Mailing address:
  • Phone: 732-614-7396
  • 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: