Healthcare Provider Details

I. General information

NPI: 1265535405
Provider Name (Legal Business Name): DANIEL JUAREZ, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE STE. 248
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

PO BOX 847
SAN ANTONIO TX
78293-0847
US

V. Phone/Fax

Practice location:
  • Phone: 210-220-3737
  • Fax: 210-220-3747
Mailing address:
  • Phone: 210-220-3737
  • Fax: 210-220-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL JUAREZ
Title or Position: EXECUTIVE OFFICER
Credential: MD
Phone: 210-220-3737