Provider Demographics
NPI:1609071489
Name:PRIETO, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:PRIETO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-4700
Mailing Address - Fax:361-694-4701
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-4700
Practice Address - Fax:361-694-4701
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-02-23
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Provider Licenses
StateLicense IDTaxonomies
TXN87082088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203286401Medicaid