Provider Demographics
NPI:1588775316
Name:CARRENO, JUANITA I
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:I
Last Name:CARRENO
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 1:28 ORANGE AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5155
Mailing Address - Country:US
Mailing Address - Phone:619-929-4258
Mailing Address - Fax:
Practice Address - Street 1:1840 WILSON AVE STE C
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5515
Practice Address - Country:US
Practice Address - Phone:619-477-0242
Practice Address - Fax:619-477-0799
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health