MEDICARE: JUAN SANTIAGO RINCON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609723816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN SANTIAGO RINCON

Provider Business Mailing Address
First Line	:	21214 HIGHLAND KNOLLS DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-5368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 AVENUE I
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:	936-294-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	05/05/2026

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Directions to “ JUAN SANTIAGO RINCON ” Practice Location

Language	Start Address	Practice Location

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