Provider Demographics
NPI:1578853776
Name:JUAREZ-GONZALEZ, MONICA (DO)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:JUAREZ-GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E GRUBB DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-285-6349
Mailing Address - Fax:972-289-6717
Practice Address - Street 1:125 E GRUBB DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-285-6349
Practice Address - Fax:972-289-6717
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
360181ZHY7OtherMEDICARE PTAN
TX183245301Medicaid
TX338225101Medicaid