Provider Demographics
NPI:1265114714
Name:BOUCHEKARA, JUNA
Entity type:Individual
Prefix:
First Name:JUNA
Middle Name:
Last Name:BOUCHEKARA
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 1:714 FOXGLOVE ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3317
Mailing Address - Country:US
Mailing Address - Phone:760-814-0644
Mailing Address - Fax:
Practice Address - Street 1:6102 AVENIDA ENCINAS STE E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1005
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist