Provider Demographics
NPI:1114652237
Name:HIMENES, JUANITA J
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:J
Last Name:HIMENES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAYNEE
Other - Middle Name:
Other - Last Name:HIMENES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1328 BLUE OAKS BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7037
Mailing Address - Country:US
Mailing Address - Phone:916-676-0488
Mailing Address - Fax:
Practice Address - Street 1:1328 BLUE OAKS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-7037
Practice Address - Country:US
Practice Address - Phone:916-676-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician