Provider Demographics
NPI:1912214545
Name:JURADO, JAMES WESTLEY (MS,CSCS, PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESTLEY
Last Name:JURADO
Suffix:
Gender:M
Credentials:MS,CSCS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7005
Mailing Address - Country:US
Mailing Address - Phone:909-548-9037
Mailing Address - Fax:
Practice Address - Street 1:1105 E BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7005
Practice Address - Country:US
Practice Address - Phone:909-548-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic