Provider Demographics
NPI:1437383593
Name:LONGORIA, JUAN F JR (LAT)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:F
Last Name:LONGORIA
Suffix:JR
Gender:M
Credentials:LAT
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Mailing Address - Street 1:3235 MEADOW BAY LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6174
Mailing Address - Country:US
Mailing Address - Phone:281-284-1467
Mailing Address - Fax:281-284-9833
Practice Address - Street 1:501 PALOMINO ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2066
Practice Address - Country:US
Practice Address - Phone:281-284-1467
Practice Address - Fax:281-284-9833
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT28022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer