Provider Demographics
NPI:1629141460
Name:LUIS JUAREZ MD PA
Entity Type:Organization
Organization Name:LUIS JUAREZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-825-9057
Mailing Address - Street 1:230 W 49 ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-0000
Mailing Address - Country:US
Mailing Address - Phone:305-825-9057
Mailing Address - Fax:305-825-3135
Practice Address - Street 1:230 W 49 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-0000
Practice Address - Country:US
Practice Address - Phone:305-825-9057
Practice Address - Fax:305-825-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067704300Medicaid
D27932Medicare UPIN
FL067704300Medicaid