Provider Demographics
NPI:1124845011
Name:CORTES DE JUAREZ, CAROL MARIA
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIA
Last Name:CORTES DE JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 HAGEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-2909
Mailing Address - Country:US
Mailing Address - Phone:386-307-7912
Mailing Address - Fax:
Practice Address - Street 1:2281 HAGEN AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-2909
Practice Address - Country:US
Practice Address - Phone:386-307-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty