Provider Demographics
NPI:1093848806
Name:JUAN, BEVERLY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JANE
Last Name:JUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SAN LEANDRO BLVD
Mailing Address - Street 2:2ND FLOOR, BLDG. C
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1598
Mailing Address - Country:US
Mailing Address - Phone:510-618-2057
Mailing Address - Fax:510-618-2077
Practice Address - Street 1:1000 SAN LEANDRO BLVD
Practice Address - Street 2:2ND FLOOR, BLDG. C
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1598
Practice Address - Country:US
Practice Address - Phone:510-618-2057
Practice Address - Fax:510-618-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42998251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare