Healthcare Provider Details

I. General information

NPI: 1821978404
Provider Name (Legal Business Name): JANELLY JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 COMMUNITY PKWY
HOLLISTER CA
95023-2816
US

IV. Provider business mailing address

1131 COMMUNITY PKWY
HOLLISTER CA
95023-2816
US

V. Phone/Fax

Practice location:
  • Phone: 831-636-4020
  • Fax: 831-636-4025
Mailing address:
  • Phone: 831-636-4020
  • Fax: 831-636-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: