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General NPI Number Information
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NPI Number | 1174781710
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Entity Type | Individual
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Provider Name | JUVERIA TAWWAB MD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 2605 W LAKE MARY BLVD #119
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City | LAKE MARY
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State | FL
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Zip | 32746-3568
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Country | US
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Telephone | 407-878-7990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 952824
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City | LAKE MARY
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State | FL
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Zip | 32795-2824
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Country | US
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Telephone | 407-302-1331
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME119485
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License Number State | FL
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