Provider Demographics
NPI:1528216553
Name:WANDA JUARROS MD FAMILY HEALTH CARE PLLC
Entity Type:Organization
Organization Name:WANDA JUARROS MD FAMILY HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JUARROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-641-4646
Mailing Address - Street 1:6336 E BROWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4842
Mailing Address - Country:US
Mailing Address - Phone:480-641-4646
Mailing Address - Fax:480-641-2270
Practice Address - Street 1:6336 E BROWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4842
Practice Address - Country:US
Practice Address - Phone:480-641-4646
Practice Address - Fax:480-641-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty