Doctor Name: | DR. JORGE MARIO JUAREZ-ASTURIAS |
NPI Number: | 1326181520 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD |
License Number: | PSY 18812 |
Business Practice Address: | 610 Pacific Coast Hwy Suite 205 Seal Beach, CA - 907406604 |
Business Phone Number: | 3234454476 |
Business Fax Number: | 3236637644 |
Mailing Address: | 3373 Rowena Ave Apt 4, LOS ANGELES |
State: | CA |
Postal Code: | 900272949 |
Phone Number: | 3234454476 |
Fax Number: | 3236637644 |
NPI Enumeration Date: | 02/15/2007 |
NPI Last Update Date: | 09/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 18812 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |