Healthcare Provider Details

I. General information

NPI: 1528006905
Provider Name (Legal Business Name): JOE VICTOR JUAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

9040 BLUE RAVEN AVE
LAS VEGAS NV
89143-1150
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3633
  • Fax:
Mailing address:
  • Phone: 702-243-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12515
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: