Provider Demographics
NPI:1073126983
Name:JUAREZ, RAENA A
Entity Type:Individual
Prefix:
First Name:RAENA
Middle Name:A
Last Name:JUAREZ
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 1:2488 SHIELD DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1925
Mailing Address - Country:US
Mailing Address - Phone:510-566-1057
Mailing Address - Fax:
Practice Address - Street 1:2488 SHIELD DR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1925
Practice Address - Country:US
Practice Address - Phone:510-566-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst