MEDICARE: DR. JOSE JAVIER URIZAR JUAREZ PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY36616	CA
2	106H00000X	Marriage & Family Therapist	MFC47346	CA

General Provider Information

NPI Number	:	1558480731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE JAVIER URIZAR JUAREZ PSYD

Provider Business Mailing Address
First Line	:	550 S PALOS VERDES ST APT 559
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-5122
Country	:	US
Telephone Number	:	818-634-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	818-634-4783
Fax Number	:	818-634-4783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	03/05/2026

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