Provider Demographics
NPI:1396048708
Name:BATES, JUANITA LASHET
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:LASHET
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7022 LIMESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-5274
Mailing Address - Country:US
Mailing Address - Phone:832-665-5111
Mailing Address - Fax:832-336-4746
Practice Address - Street 1:7022 LIMESTONE CIR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-5274
Practice Address - Country:US
Practice Address - Phone:832-665-5111
Practice Address - Fax:832-336-4746
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization