Provider Demographics
NPI:1285664243
Name:JUAREZ, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 HERNDON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6307
Mailing Address - Country:US
Mailing Address - Phone:559-432-3434
Mailing Address - Fax:
Practice Address - Street 1:1381 E HERNDON AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3307
Practice Address - Country:US
Practice Address - Phone:559-432-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02396Medicare UPIN
CA00G736011Medicare PIN