Provider Demographics
NPI:1417464736
Name:ANZURES, JUAN EMMANUEL JR (NP)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:EMMANUEL
Last Name:ANZURES
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E MAIN DR STE 600
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1385
Mailing Address - Country:US
Mailing Address - Phone:915-887-3410
Mailing Address - Fax:915-351-3643
Practice Address - Street 1:725 S. MESA HILLS DR.
Practice Address - Street 2:BLDG 1, STE 1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-887-3410
Practice Address - Fax:915-351-4467
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136174363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384199101Medicaid