Provider Demographics
NPI:1790417509
Name:JUAREZ, KARELY
Entity Type:Individual
Prefix:
First Name:KARELY
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 16TH ST APT 323
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7661
Mailing Address - Country:US
Mailing Address - Phone:619-327-6775
Mailing Address - Fax:
Practice Address - Street 1:1750 AVENIDA DEL MUNDO UNIT 302
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3093
Practice Address - Country:US
Practice Address - Phone:619-435-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD7561389OtherDRIVER LICENSE