Most Relevant Information
Provider Data
| NPI Number: | 1003496969 |
| Provider Name: | JESUS E JUAREZ CASILLAS |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/13/2021 |
| Last Updated: | 12/10/2021 |
Provider Practice Location
17234 VALLEY BLVD
BUILDING A
FONTANA
CA
923356720
Practice Location Phone/Fax
| Phone: | 9094274128 |
| Fax: |
Provider Mailing Location
17234 VALLEY BLVD
BUILDING A
FONTANA
CA
923356720
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |