Provider Demographics
NPI:1629632393
Name:INIGUEZ, JUAN ANTONIO
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:INIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17789 BLAKE LN UNIT 66
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4595
Mailing Address - Country:US
Mailing Address - Phone:909-684-0398
Mailing Address - Fax:
Practice Address - Street 1:17789 BLAKE LN UNIT 66
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4595
Practice Address - Country:US
Practice Address - Phone:909-684-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)