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General NPI Number Information
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NPI Number | 1528216553
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Entity Type | Organization
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Legal Business Name | WANDA JUARROS MD FAMILY HEALTH CARE PLLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 6336 E BROWN RD SUITE 101
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City | MESA
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State | AZ
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Zip | 85205-4842
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Country | US
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Telephone | 480-641-4646
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Fax | 480-641-2270
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Provider Business Mailing Address
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Address Line | 6336 E BROWN RD SUITE 101
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City | MESA
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State | AZ
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Zip | 85205-4842
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Country | US
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Telephone | 480-641-4646
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Fax | 480-641-2270
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. WANDA D JUARROS
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Credential | M.D.
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Telephone | 480-641-4646
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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 | 26518
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License Number State | AZ
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