Provider Demographics
NPI:1306895602
Name:SOLIVEN, JUAN CARLOS VEGA (MD)
Entity type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:VEGA
Last Name:SOLIVEN
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 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:CHRISTUS CABRINI GROUP PRACTICE INTENSIVISTS
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:318-448-6700
Practice Address - Fax:318-483-4066
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD12724R207RP1001X, 207RC0200X
LAMD.12724R208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03837510Medicaid
LA1546593Medicaid
G83914Medicare UPIN
LA1546593Medicaid
LA278663YH3UMedicare PIN
5E147Medicare PIN
LAP00345017Medicare PIN
LA278663YJBAMedicare PIN