Provider Demographics
NPI:1326503558
Name:JUAREZ-LOGAN, CINDI NICOLE (BS)
Entity Type:Individual
Prefix:
First Name:CINDI
Middle Name:NICOLE
Last Name:JUAREZ-LOGAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SEABURY DR APT Q131
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3122
Mailing Address - Country:US
Mailing Address - Phone:209-487-2767
Mailing Address - Fax:
Practice Address - Street 1:4200 SEABURY DR APT Q131
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3122
Practice Address - Country:US
Practice Address - Phone:209-487-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT74512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty