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General NPI Number Information
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NPI Number | 1407398639
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Entity Type | Individual
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Provider Name | LAURA ELISE JUAREZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 1265 S UTICA AVE STE 105
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City | TULSA
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State | OK
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Zip | 74104-4243
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Country | US
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Telephone | 918-592-0999
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Fax | 918-592-1021
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Provider Business Mailing Address
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Address Line | PO BOX 615
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City | DORADO
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State | PR
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Zip | 00646-0615
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Country | US
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Telephone | 801-362-6791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 000919
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4749
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 56826
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License Number State | CA
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