Provider Demographics
NPI:1508849944
Name:PUENTES, JAIRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:A
Last Name:PUENTES
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 1:5920 SARATOGA BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4137
Mailing Address - Country:US
Mailing Address - Phone:361-852-0852
Mailing Address - Fax:361-852-2280
Practice Address - Street 1:5920 SARATOGA BLVD STE 395
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4137
Practice Address - Country:US
Practice Address - Phone:361-852-0852
Practice Address - Fax:361-852-2280
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2071208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83670SOtherBCBS
TX099595302Medicaid
TX099595302Medicaid