Provider Demographics
NPI:1922286418
Name:JUANLU, JEFFREY C (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:JUANLU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PATERSON PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6759
Mailing Address - Country:US
Mailing Address - Phone:408-645-5547
Mailing Address - Fax:925-820-7996
Practice Address - Street 1:355 DARDANELLI LN
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1438
Practice Address - Country:US
Practice Address - Phone:408-866-4036
Practice Address - Fax:408-871-7491
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9758208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist