Healthcare Provider Details

I. General information

NPI: 1750450169
Provider Name (Legal Business Name): JOHN M MIGUELEZ CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WRAMC SUITE 3H 6900 GEORGIA AVE NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

123 W TORRANCE BLVD SUITE 203
REDONDO BEACH CA
90277-3610
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-9830
  • Fax: 202-782-4365
Mailing address:
  • Phone: 310-372-3050
  • Fax: 310-372-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCP001751
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: