Provider Demographics
NPI:1669702940
Name:JUAREZ & JUAREZ FAMILY MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:JUAREZ & JUAREZ FAMILY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:REGINO
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:210-681-6380
Mailing Address - Street 1:4151 CALLAGHAN RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3476
Mailing Address - Country:US
Mailing Address - Phone:210-681-6380
Mailing Address - Fax:210-521-6200
Practice Address - Street 1:4151 CALLAGHAN RD
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3476
Practice Address - Country:US
Practice Address - Phone:210-681-6380
Practice Address - Fax:210-521-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00ML01OtherMEDICARE ID
TX110270902Medicaid
TX110270902Medicaid