Individual
DR. JUAN CARLOS CUCALON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4404
(209) 214-1211
Mailing address
1441 FLORIDA AVE, MODESTO, CA 95350-4404
(209) 214-1211
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C170661
CA
207L00000X
Anesthesiology Physician
ME86152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266805000
—
FL
01
—
71471
B/C & B/S OF FL
FL
Enumeration date
11/11/2005
Last updated
11/25/2020
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