Provider Demographics
NPI:1467454058
Name:JUAREZ, RAFAEL GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:GREGORY
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:GREGORY
Other - Last Name:JUAREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2440 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2648
Mailing Address - Country:US
Mailing Address - Phone:702-564-1858
Mailing Address - Fax:702-564-8058
Practice Address - Street 1:2440 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2648
Practice Address - Country:US
Practice Address - Phone:702-564-1858
Practice Address - Fax:702-564-8058
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7003207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019521Medicaid
NV37792Medicare ID - Type UnspecifiedNORIDIAN
NVF83040Medicare UPIN