Provider Demographics
NPI:1861452807
Name:JUAREZ, HILARIO (MD)
Entity Type:Individual
Prefix:
First Name:HILARIO
Middle Name:
Last Name:JUAREZ
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 1:10810 N TATUM BLVD STE 102306
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-0503
Mailing Address - Country:US
Mailing Address - Phone:602-252-1510
Mailing Address - Fax:
Practice Address - Street 1:1310 N 24TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4617
Practice Address - Country:US
Practice Address - Phone:602-252-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64148OtherPTAN
AZ238726OtherAHCCCS
AZ64148OtherPTAN