Healthcare Provider Details

I. General information

NPI: 1245134022
Provider Name (Legal Business Name): KEVIN JAUREGUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD # 211
CHARLOTTE NC
28211-5055
US

IV. Provider business mailing address

330 BILLINGSLEY RD # 211
CHARLOTTE NC
28211-5055
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-9911
  • Fax:
Mailing address:
  • Phone: 704-200-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: