Healthcare Provider Details

I. General information

NPI: 1427795525
Provider Name (Legal Business Name): DIONNE LOUISE JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SAN JACINTO AVE
PERRIS CA
92571-2833
US

IV. Provider business mailing address

63 S 4TH ST
BANNING CA
92220-4861
US

V. Phone/Fax

Practice location:
  • Phone: 951-210-1639
  • Fax:
Mailing address:
  • Phone: 951-791-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: