Provider Demographics
NPI:1922821685
Name:JAUREGUI, FRANCISCO IVAN
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:IVAN
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:PO BOX 2712
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-2712
Mailing Address - Country:US
Mailing Address - Phone:909-738-2726
Mailing Address - Fax:
Practice Address - Street 1:753 SAN JOAQUIN AVE
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-8535
Practice Address - Country:US
Practice Address - Phone:909-738-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician