Provider Demographics
NPI:1497127203
Name:JUAREZ, ROXANA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16946 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3613
Mailing Address - Country:US
Mailing Address - Phone:818-401-0661
Mailing Address - Fax:818-401-0663
Practice Address - Street 1:397 MOBIL AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6310
Practice Address - Country:US
Practice Address - Phone:805-384-1410
Practice Address - Fax:805-484-1301
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst