Provider Demographics
NPI:1730458787
Name:WALTERSPIEL, JUAN N (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:N
Last Name:WALTERSPIEL
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:PROF
Other - First Name:JUAN
Other - Middle Name:N
Other - Last Name:WALTERSPIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,FAAP
Mailing Address - Street 1:2311 WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1549
Mailing Address - Country:US
Mailing Address - Phone:678-910-3609
Mailing Address - Fax:
Practice Address - Street 1:2311 WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1549
Practice Address - Country:US
Practice Address - Phone:678-910-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52365261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty