Provider Demographics
NPI:1508971623
Name:JUAREZ, KYOMI RENEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KYOMI
Middle Name:RENEE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1099 E CHAMPLAIN DR
Mailing Address - Street 2:STE A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5030
Mailing Address - Country:US
Mailing Address - Phone:559-432-3434
Mailing Address - Fax:559-432-3585
Practice Address - Street 1:6191 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8612
Practice Address - Country:US
Practice Address - Phone:559-432-3434
Practice Address - Fax:559-432-3585
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP15039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31007ZMedicare ID - Type Unspecified