Provider Demographics
NPI:1558480731
Name:JUAREZ, JOSE JAVIER URIZAR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE JAVIER
Middle Name:URIZAR
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:JAVIER
Other - Last Name:JUAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:9938 SEPULVEDA BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2990
Mailing Address - Country:US
Mailing Address - Phone:818-634-4783
Mailing Address - Fax:
Practice Address - Street 1:12021 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3019
Practice Address - Country:US
Practice Address - Phone:818-634-4783
Practice Address - Fax:818-634-4783
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
CAMFC47346106H00000X, 106H00000X
CAPSB94027661390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACBSC566OtherLA DMH PROVIDER
CA00007300Medicaid