Individual
MS. TERRI L JUAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 E DONLON ST APT 2456B, BLYTHE, CA 92225-3039
(951) 390-5818
Mailing address
2200 E DONLON ST APT 2456B, BLYTHE, CA 92225-3039
(951) 390-5818
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
B4889035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-2539459
IEHP MOLINA ACCESS
CA
05
—
86-2539459
—
CA
05
—
89-2539459
—
CA
Enumeration date
10/19/2022
Last updated
10/19/2022
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