Provider Demographics
NPI:1023564531
Name:CARRALES, JUAN JOSE (PA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:CARRALES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:EDCOUCH
Mailing Address - State:TX
Mailing Address - Zip Code:78538-2158
Mailing Address - Country:US
Mailing Address - Phone:956-262-1363
Mailing Address - Fax:956-262-1840
Practice Address - Street 1:1518 E SANTA ROSA AVE
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538-2158
Practice Address - Country:US
Practice Address - Phone:956-262-1363
Practice Address - Fax:956-262-1840
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1132749OtherNCCPA CERTIFICATION
TXPA10556OtherTX MEDICAL BOARD - LICENSE