Basic Information
| Provider Information | |||||||||
| NPI: | 1619273364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUAN | ||||||||
| FirstName: | GEORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1399 YGNACIO VALLEY RD | ||||||||
| Address2: | STE 14 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259390103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1399 YGNACIO VALLEY RD | ||||||||
| Address2: | STE 14 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259390103 | ||||||||
| FaxNumber: | 9259393057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2011 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
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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 | 207RP1001X | A141456 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.