Provider Demographics
NPI:1124064829
Name:CONTRERAS, JUAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W CHERRY ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274
Mailing Address - Country:US
Mailing Address - Phone:559-684-7800
Mailing Address - Fax:559-684-7804
Practice Address - Street 1:922 N CHERRY ST
Practice Address - Street 2:SUITE B
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2210
Practice Address - Country:US
Practice Address - Phone:559-684-7800
Practice Address - Fax:559-684-7804
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14734Medicaid
CAPA14734Medicaid
CA0PA147340Medicare Oscar/Certification