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General NPI Number Information
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NPI Number | 1942348719
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Entity Type | Individual
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Provider Name | VICENTE MARIO JUAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 1425 SANTA FE
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-2105
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Country | US
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Telephone | 361-887-9995
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Fax | 361-887-8464
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Provider Business Mailing Address
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Address Line | 1425 SANTA FE
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-2105
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Country | US
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Telephone | 361-887-9995
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Fax | 361-887-8464
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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 | F1691
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License Number State | TX
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