Provider Demographics
NPI:1588157655
Name:JUAREZ, DASY NALLELY
Entity type:Individual
Prefix:
First Name:DASY
Middle Name:NALLELY
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 1:111 BROOKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2107
Mailing Address - Country:US
Mailing Address - Phone:831-269-2634
Mailing Address - Fax:
Practice Address - Street 1:111 BROOKSIDE PL
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2107
Practice Address - Country:US
Practice Address - Phone:831-269-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst