Doctor Name: | MR. JUAN CARLOS HERRAEZ SANCHEZ |
NPI Number: | 1023342961 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 2876 |
Business Practice Address: | 1008 Minnequa Ave Pueblo, CO - 810043733 |
Business Phone Number: | 7195575656 |
Business Fax Number: | 7195574715 |
Mailing Address: | 445 E Cheyenne Mountain Blvd Ste C, Pmb 406 COLORADO SPRINGS |
State: | CO |
Postal Code: | 809064570 |
Phone Number: | 7195388100 |
Fax Number: | 7195388003 |
NPI Enumeration Date: | 09/24/2009 |
NPI Last Update Date: | 10/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2876 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |