Provider Demographics
NPI:1851071138
Name:JUAREZ, VANESSA JASMINE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JASMINE
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 1:5835 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4029
Mailing Address - Country:US
Mailing Address - Phone:323-725-4623
Mailing Address - Fax:
Practice Address - Street 1:5835 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4029
Practice Address - Country:US
Practice Address - Phone:323-725-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker