Provider Demographics
NPI:1558182881
Name:IZAGUIRRE ESQUIVEL, JUAN JOSE (C-SA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:IZAGUIRRE ESQUIVEL
Suffix:
Gender:M
Credentials:C-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 SW 82ND ST APT K412
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7311
Mailing Address - Country:US
Mailing Address - Phone:786-710-3075
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 82ND ST APT K412
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7311
Practice Address - Country:US
Practice Address - Phone:786-710-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-466246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant