Provider Demographics
NPI:1346524410
Name:JUNIPER, JOHN STEPHEN (MS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:JUNIPER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12908 RIMMON RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3439
Mailing Address - Country:US
Mailing Address - Phone:951-205-9191
Mailing Address - Fax:
Practice Address - Street 1:12908 RIMMON RD
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3439
Practice Address - Country:US
Practice Address - Phone:951-205-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPPS 120001848101YS0200X, 101YS0200X
CAPCI 18101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XOtherMEDI-CAL