Provider Demographics
NPI:1316423528
Name:JUAREZ, ANGELICA (MD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3547
Mailing Address - Country:US
Mailing Address - Phone:562-264-4859
Mailing Address - Fax:562-432-9590
Practice Address - Street 1:2125 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-3547
Practice Address - Country:US
Practice Address - Phone:562-264-4859
Practice Address - Fax:562-432-9590
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL4512208000000X
CAA179692208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program