Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | CA |
NPI | 1184385908 |
---|---|
Provider Name | Stephanie Juarez |
First Address | Stockton, CA 95215-8213 |
Second Address | Stockton, CA 95215-8213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2022 |
Last Update Date | 04/01/2022 |