MEDICARE: MR. ALBERT JUAREZ JR. PA-C

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	363A00000X	Physician Assistant	PA14104	TX

General Provider Information

NPI Number	:	1689950891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT JUAREZ JR. PA-C

Provider Business Mailing Address
First Line	:	1201 DULLES AVE APT 4305
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-5729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST., STE 2800
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1541
Country	:	US
Telephone Number	:	713-486-8000
Fax Number	:	713-486-8088

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

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/12/2021

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