Provider Demographics
NPI:1558429571
Name:JUAREZ, SERGIO (RT)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 PASEO HERMOSO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8419
Mailing Address - Country:US
Mailing Address - Phone:915-566-7584
Mailing Address - Fax:
Practice Address - Street 1:2871 PERSHING DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2423
Practice Address - Country:US
Practice Address - Phone:915-566-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718059163WC3500X
TX588642278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
Not Answered2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation