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General NPI Number Information
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NPI Number | 1467091355
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Entity Type | Organization
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Legal Business Name | JUVANTE INC
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | #49 27 DE FEBRERO
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City | PUERTO PLATA
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State | PUERTO PLATA
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Zip | 57000
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Country | DO
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Telephone | 809-517-6312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3941
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City | PORTSMOUTH
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State | VA
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Zip | 23701-0941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JULIAN JACKSON
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Credential |
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Telephone | 202-860-3713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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