Provider Demographics
NPI:1326222308
Name:JUAREZ, JASON L (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40115 BUCKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3816
Mailing Address - Country:US
Mailing Address - Phone:760-470-5128
Mailing Address - Fax:
Practice Address - Street 1:40115 BUCKWOOD WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3816
Practice Address - Country:US
Practice Address - Phone:760-470-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman