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General NPI Number Information
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NPI Number | 1376914440
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Entity Type | Individual
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Provider Name | JUAN SUN JR. LVN
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Gender | Male
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1161 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91911-3136
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Country | US
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Telephone | 619-498-8260
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Fax | 619-498-8265
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Provider Business Mailing Address
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Address Line | 2251 SMYTHE AVE
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2436
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Country | US
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Telephone | 619-210-3367
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 283576
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License Number State | CA
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