Provider Demographics
NPI:1417130659
Name:JUAREZ, LUIS CARLOS JR (PA, DC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:CARLOS
Last Name:JUAREZ
Suffix:JR
Gender:M
Credentials:PA, DC
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8205
Mailing Address - Fax:956-362-8209
Practice Address - Street 1:2821 MICHAELANGELO DR STE 102
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1411
Practice Address - Country:US
Practice Address - Phone:956-362-8205
Practice Address - Fax:956-362-8209
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9454111N00000X
TXPA05458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor