Provider Demographics
NPI:1366184863
Name:JAUREGUI, HELEAZIN
Entity type:Individual
Prefix:
First Name:HELEAZIN
Middle Name:
Last Name:JAUREGUI
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 1:77 WEST LOOP
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4950
Mailing Address - Country:US
Mailing Address - Phone:559-706-5874
Mailing Address - Fax:
Practice Address - Street 1:1182 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-1582
Practice Address - Country:US
Practice Address - Phone:559-675-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE