MEDICARE: JUAN C CIFUENTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265463905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN C CIFUENTES

Provider Business Mailing Address
First Line	:	10938 VANOWEN ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6407
Country	:	US
Telephone Number	:	818-760-2461
Fax Number	:	818-760-1105

Provider Business Practice Location Address
First Line	:	10938 VANOWEN ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6407
Country	:	US
Telephone Number	:	818-760-2461
Fax Number	:	818-760-1105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/03/2019

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Directions to “ JUAN C CIFUENTES ” Practice Location

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