Provider Demographics
NPI:1578128492
Name:JUAREZ, ADAHLY
Entity Type:Individual
Prefix:
First Name:ADAHLY
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 1:12440 FIRESTONE BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-9319
Mailing Address - Country:US
Mailing Address - Phone:562-864-3722
Mailing Address - Fax:562-864-4596
Practice Address - Street 1:12440 FIRESTONE BLVD STE 316
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-9319
Practice Address - Country:US
Practice Address - Phone:562-864-3722
Practice Address - Fax:562-864-4596
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker