1033477559 NPI number — MRS. OFELIA S JUAREZ LHAS

Table of content: MRS. OFELIA S JUAREZ LHAS (NPI 1033477559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033477559 NPI number — MRS. OFELIA S JUAREZ LHAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUAREZ
Provider First Name:
OFELIA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LHAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033477559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 N ED CAREY DR
Provider Second Line Business Mailing Address:
STE. # 100
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-7508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-425-3298
Provider Business Mailing Address Fax Number:
956-425-4321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 N ED CAREY DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-7508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-425-3298
Provider Business Practice Location Address Fax Number:
956-425-4321
Provider Enumeration Date:
05/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  50094 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1127755-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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