Healthcare Provider Details

I. General information

NPI: 1114766904
Provider Name (Legal Business Name): JUHI DHUKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 E NEW HOPE DR BLDG D
CEDAR PARK TX
78641-5760
US

IV. Provider business mailing address

1513 E NEW HOPE DR BLDG D
CEDAR PARK TX
78641-5760
US

V. Phone/Fax

Practice location:
  • Phone: 512-267-6046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17692
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: