Healthcare Provider Details

I. General information

NPI: 1235092453
Provider Name (Legal Business Name): OLIVIA MARISOL JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 MCHENRY AVE
MODESTO CA
95350-1400
US

IV. Provider business mailing address

2300 ORCHARD PARK WAY
MODESTO CA
95355-9110
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-4546
  • Fax:
Mailing address:
  • Phone: 209-607-1697
  • 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: