Basic Information
| Provider Information | |||||||||
| NPI: | 1275786626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMEZ | ||||||||
| FirstName: | JUAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14507 W SUNSET AVE | ||||||||
| Address2: | |||||||||
| City: | KERMAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936301450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598432392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3467 W SHAW AVE | ||||||||
| Address2: | SUITE # 102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937113223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592740299 | ||||||||
| FaxNumber: | 5592740292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2008 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | CA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.