Healthcare Provider Details

I. General information

NPI: 1053144782
Provider Name (Legal Business Name): RAFAEL JUAREZ III LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

IV. Provider business mailing address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-564-7577
  • Fax: 915-564-7839
Mailing address:
  • Phone: 915-564-7577
  • Fax: 915-564-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number141144
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: