Provider Demographics
NPI:1174852230
Name:JUAREZ, LUIS ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEJANDRO
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD STE 113
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7902
Practice Address - Country:US
Practice Address - Phone:916-478-6561
Practice Address - Fax:916-478-6573
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine