Healthcare Provider Details

I. General information

NPI: 1720924095
Provider Name (Legal Business Name): FERNANDO MANUEL JUAREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 E BUSTAMANTE ST OFC 1.1059
LAREDO TX
78041-5416
US

IV. Provider business mailing address

1937 E BUSTAMANTE ST
LAREDO TX
78041-5416
US

V. Phone/Fax

Practice location:
  • Phone: 956-523-7413
  • Fax: 210-450-2419
Mailing address:
  • Phone: 956-415-7722
  • Fax: 210-450-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number49027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: