MEDICARE: LESLIE JUAREZ

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1447771209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JUAREZ

Provider Business Mailing Address
First Line	:	2820 SARATOGA RD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-4600
Country	:	US
Telephone Number	:	307-258-1827
Fax Number	:	307-237-0632

Provider Business Practice Location Address
First Line	:	2820 SARATOGA RD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-4600
Country	:	US
Telephone Number	:	307-258-1827
Fax Number	:	307-237-0632

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

Provider Enumeration Date	:	07/02/2017
Last Update Date	:	03/17/2018

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Directions to “ LESLIE JUAREZ ” Practice Location

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