Healthcare Provider Details

I. General information

NPI: 1396113874
Provider Name (Legal Business Name): CESAR AUGUSTO JUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 RHODE ISLAND AVE NW APT 520
WASHINGTON DC DC
20005
US

IV. Provider business mailing address

1415 RHODE ISLAND AVE NW APT 520
WASHINGTON DC
20005-5412
US

V. Phone/Fax

Practice location:
  • Phone: 202-246-3312
  • Fax:
Mailing address:
  • Phone: 240-645-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberNA00606780
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: