Provider Demographics
NPI:1588619027
Name:CESAR JURADO
Entity Type:Organization
Organization Name:CESAR JURADO
Other - Org Name:THERAPEUTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:CPED,CFO, BS
Authorized Official - Phone:915-613-2103
Mailing Address - Street 1:1810 MURCHISON DR
Mailing Address - Street 2:STE 220
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2906
Mailing Address - Country:US
Mailing Address - Phone:915-613-2103
Mailing Address - Fax:915-533-2103
Practice Address - Street 1:1810 MURCHISON DR
Practice Address - Street 2:STE 220
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2906
Practice Address - Country:US
Practice Address - Phone:915-613-2103
Practice Address - Fax:915-533-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091143332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185077802Medicaid
TX185077803OtherMEDICAID CCP
TX4855760001Medicare NSC