Provider Demographics
NPI:1538693304
Name:JUAREZ, DAISY
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
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 1:1722 W CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2944
Mailing Address - Country:US
Mailing Address - Phone:714-654-6247
Mailing Address - Fax:
Practice Address - Street 1:11822 SANTA PAULA ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3529
Practice Address - Country:US
Practice Address - Phone:714-379-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist