Healthcare Provider Details

I. General information

NPI: 1861269938
Provider Name (Legal Business Name): JUAN CARLOS NARVAEZ GONZALEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 MEDICAL DR
PECOS TX
79772-2251
US

IV. Provider business mailing address

2349 MEDICAL DR
PECOS TX
79772-2251
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-3551
  • Fax: 432-447-5434
Mailing address:
  • Phone: 432-447-3551
  • Fax: 432-447-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1151722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: