Basic Information
| Provider Information | |||||||||
| NPI: | 1578810958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAQUERANO RAIS | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CARLOS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3915 SPENCER HWY | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132656955 | ||||||||
| FaxNumber: | 8338452869 | ||||||||
| Practice Location | |||||||||
| Address1: | 3915 SPENCER HWY | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136739000 | ||||||||
| FaxNumber: | 8558958155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2012 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q0589 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.