Provider Demographics
NPI:1194151837
Name:ZURITA JR, JUAN MIGUEL
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MIGUEL
Last Name:ZURITA JR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5723 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4222
Mailing Address - Country:US
Mailing Address - Phone:323-721-6855
Mailing Address - Fax:323-721-8631
Practice Address - Street 1:5723 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4222
Practice Address - Country:US
Practice Address - Phone:323-721-6855
Practice Address - Fax:323-721-8631
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA886343026OtherSUBSTANCE ABUSE COUNSELOR