MEDICARE: JUANA BRENDA CHAIREZ

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1780340430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA BRENDA CHAIREZ

Provider Business Mailing Address
First Line	:	1507 COLONY EAST CIR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-5408
Country	:	US
Telephone Number	:	562-241-9704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 COLONY EAST CIR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-5408
Country	:	US
Telephone Number	:	562-241-3704
Fax Number	:

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

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	11/16/2021

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Directions to “ JUANA BRENDA CHAIREZ ” Practice Location

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