Healthcare Provider Details

I. General information

NPI: 1801789649
Provider Name (Legal Business Name): SEBASTIAN JUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD STE 408
LOS ANGELES CA
90045-3950
US

IV. Provider business mailing address

2128 RONSARD RD
RCH PALOS VRD CA
90275-1624
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7827
  • Fax:
Mailing address:
  • Phone: 310-418-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: