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NPI Code Detail

MEDICARE: MR. CARLOS EDUARDO JUAREZ AGUILAR OCCUPATIONAL THERAPI

MEDICARE: MR. CARLOS EDUARDO JUAREZ AGUILAR OCCUPATIONAL THERAPI
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
1225XM0800XMental Health Occupational Therapist20728CA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1992224646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARLOS EDUARDO JUAREZ AGUILAR OCCUPATIONAL THERAPI
Provider Business Mailing Address
First Line : 4601 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-2729
Country : US
Telephone Number : 323-803-3881
Fax Number :
Provider Business Practice Location Address
First Line : 4601 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-2729
Country : US
Telephone Number : 323-803-3881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 07/07/2023

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