Healthcare Provider Details

I. General information

NPI: 1033406640
Provider Name (Legal Business Name): JUAN PABLO GURRIA JUAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. MLC 2023
CINCINNATI OH
45229-7710
US

IV. Provider business mailing address

3333 BURNET AVE. MLC 2023
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-517-7170
  • Fax:
Mailing address:
  • Phone: 513-517-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35.128379
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number58839
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35.128379
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: