Provider Demographics
NPI:1376319426
Name:JUAREZ GALVEZ, JOANNA GRICELDA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRICELDA
Last Name:JUAREZ GALVEZ
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 1:2332 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-2214
Mailing Address - Country:US
Mailing Address - Phone:562-537-8251
Mailing Address - Fax:
Practice Address - Street 1:2332 E 130TH ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-2214
Practice Address - Country:US
Practice Address - Phone:562-537-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst