Healthcare Provider Details

I. General information

NPI: 1235022120
Provider Name (Legal Business Name): VINCENT R JUAREZ MFT TRAINEE
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: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S OAKLAND AVE
PASADENA CA
91101-2561
US

IV. Provider business mailing address

170 S OAKLAND AVE
PASADENA CA
91101-2561
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-8403
  • Fax: 818-242-3187
Mailing address:
  • Phone: 818-242-8403
  • Fax: 818-242-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: