Provider Information for 1891099909
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Mrs. JUANITA EQUILS
Sex: Female
NPI: 1891099909
Last Updated: 2015-02-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1891099909 | ||||||||
| Enumeration Date | 2011-01-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 566 S BRAND BLVD SAN FERNANDO, CA 91340-4002 United States Phone: 818-898-0223 | Fax:818-361-5384 | ||||||||
| Primary Practice Address | 566 S BRAND BLVD SAN FERNANDO, CA 91340-4002 United States Phone: 818-898-0223 | Fax:818-361-5384 | ||||||||
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