Provider Demographics
NPI:1750450169
Name:MIGUELEZ, JOHN M (CP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:MIGUELEZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 W TORRANCE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3610
Mailing Address - Country:US
Mailing Address - Phone:310-372-3050
Mailing Address - Fax:310-372-3057
Practice Address - Street 1:2 WRAMC SUITE 3H
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-9830
Practice Address - Fax:202-782-4365
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCCP001751247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other