Provider Demographics
NPI:1386125144
Name:JUAREZ, YANIRA I
Entity type:Individual
Prefix:MISS
First Name:YANIRA
Middle Name:I
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 1:31 EUCALYPTUS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2706
Mailing Address - Country:US
Mailing Address - Phone:831-540-5347
Mailing Address - Fax:
Practice Address - Street 1:31 EUCALYPTUS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2706
Practice Address - Country:US
Practice Address - Phone:831-540-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94668852DMedicaid