Individual
MRS. ALISE MARIE JUANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
55 FAIR DR, ATTN: ATHLETICS, COSTA MESA, CA 92626-6520
(714) 556-3610
(714) 662-5259
Mailing address
55 FAIR DR, ATTN: ATHLETICS, COSTA MESA, CA 92626-6520
(714) 556-3610
(714) 662-5259
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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