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General NPI Number Information
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NPI Number | 1144087958
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Entity Type | Individual
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Provider Name | ABIGAIL ANN ABELLA JUAREZ
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST STE 280
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City | GARDENA
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State | CA
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Zip | 90248-4305
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Country | US
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Telephone | 877-515-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 370 E 248TH ST
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City | CARSON
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State | CA
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Zip | 90745-6442
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Country | US
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Telephone | 310-972-0671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95357505
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License Number State | CA
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