1952477465 NPI number — ROBERT JUAREZ JR. PHYSICAL THERAPIST

Table of content: ROBERT JUAREZ JR. PHYSICAL THERAPIST (NPI 1952477465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952477465 NPI number — ROBERT JUAREZ JR. PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUAREZ
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JUAREZ
Provider Other First Name:
ROBERT
Provider Other Middle Name:
ALLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952477465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 SUNSET PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-861-8071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 BALDWIN PARK BLVD
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE BALDWIN PARK
Provider Business Practice Location Address City Name:
BALDWIN PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-851-5588
Provider Business Practice Location Address Fax Number:
626-851-5025
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  28398 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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