Provider Demographics
NPI:1972833440
Name:JUANIDAD CORPORATION
Entity Type:Organization
Organization Name:JUANIDAD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESTANISLAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-254-8215
Mailing Address - Street 1:209 DALMATIAN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2304
Mailing Address - Country:US
Mailing Address - Phone:702-254-8215
Mailing Address - Fax:702-254-8215
Practice Address - Street 1:209 DALMATIAN LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2304
Practice Address - Country:US
Practice Address - Phone:702-254-8215
Practice Address - Fax:702-254-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty