Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 312205 | LA |
NPI | 1063865038 |
---|---|
Provider Name | Vinay Kumar Juneja |
First Address | Columbia, SC 29203 |
Second Address | Lafayette, LA 70508-6984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 26/07/2019 |