Provider Demographics
NPI:1164820007
Name:CRESPIN, JUAN (ADMINISTRATOR/OWNER)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:CRESPIN
Suffix:
Gender:M
Credentials:ADMINISTRATOR/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N RESLER DR
Mailing Address - Street 2:SUITE 104-115
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1403
Mailing Address - Country:US
Mailing Address - Phone:915-229-0700
Mailing Address - Fax:800-891-8582
Practice Address - Street 1:374 BENTRIDGE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1252
Practice Address - Country:US
Practice Address - Phone:915-229-0700
Practice Address - Fax:800-891-8582
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0165443747P1801X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker