MEDICARE: JOSE A. ZUNIGA JUAREZ PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902473325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A. ZUNIGA JUAREZ PA-C

Provider Business Mailing Address
First Line	:	3822 YELLOW MOUNTAIN RD SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-5851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3822 YELLOW MOUNTAIN RD SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-5851
Country	:	US
Telephone Number	:	540-355-9045
Fax Number	:

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	03/30/2022

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