Provider Demographics
NPI:1982934253
Name:JUAREZ, AILENE ANDAL (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:AILENE
Middle Name:ANDAL
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 BIRCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1924
Mailing Address - Country:US
Mailing Address - Phone:949-475-1002
Mailing Address - Fax:949-475-1003
Practice Address - Street 1:4341 BIRCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1924
Practice Address - Country:US
Practice Address - Phone:949-475-1002
Practice Address - Fax:949-475-1003
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist