Individual
DR. COREY JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17 CHURCH HILL RD, TRUMBULL, CT 06611-3116
(203) 696-3550
Mailing address
17 CHURCH HILL RD, APT 5E, TRUMBULL, CT 06611-3116
(203) 696-3550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
048223
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008017106
—
CT
Enumeration date
01/15/2009
Last updated
10/10/2017
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