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NPI Code Detail

MEDICARE: MR. MIGUEL ANGEL JUAREZ M.A,

MEDICARE: MR. MIGUEL ANGEL JUAREZ M.A,
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
1101YA0400XAddiction (Substance Use Disorder) Counselor20005046536CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120005046536OTHERCAMEDICAL ASSISTANT

General Provider Information

NPI Number : 1831266626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MIGUEL ANGEL JUAREZ M.A,
Provider Business Mailing Address
First Line : 20 19TH ST
Second Line :
City : RICHMOND
State : CA
Zip : 94801-3618
Country : US
Telephone Number : 415-410-5267
Fax Number :
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/08/2007

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