Individual
MR. FERNANDO JUAREZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OTHER
Contact information
Practice address
4643 DOCK RD, BLDG 524, PORT HUENEME, CA 93043-4321
(805) 982-4261
(805) 982-3246
Mailing address
4643 DOCK RD, BLDG 524, PORT HUENEME, CA 93043-4321
(805) 982-4261
(805) 982-3246
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TRIWEST
MILITARY
—
Enumeration date
03/07/2006
Last updated
07/08/2007
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