Provider Demographics
NPI:1659884278
Name:J & D HEALTHCARE INC
Entity Type:Organization
Organization Name:J & D HEALTHCARE INC
Other - Org Name:JUNIX MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:MANZANO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP
Authorized Official - Phone:626-757-1984
Mailing Address - Street 1:9635 MONTE VISTA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2235
Mailing Address - Country:US
Mailing Address - Phone:909-906-3446
Mailing Address - Fax:909-966-4450
Practice Address - Street 1:9635 MONTE VISTA AVE STE 204
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2235
Practice Address - Country:US
Practice Address - Phone:909-906-3446
Practice Address - Fax:909-966-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty