Healthcare Provider Details

I. General information

NPI: 1518202381
Provider Name (Legal Business Name): CHRISTIAN DJUANDA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN
DALLAS TX
75230-2571
US

IV. Provider business mailing address

15 SWALLOW TAIL CT
THE WOODLANDS TX
77381-3816
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08193
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08193
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: