Healthcare Provider Details

I. General information

NPI: 1164326435
Provider Name (Legal Business Name): MR. JORGE JUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 IOWA AVE
RIVERSIDE CA
92507-0520
US

IV. Provider business mailing address

5504 RUTLAND AVE
RIVERSIDE CA
92503-2441
US

V. Phone/Fax

Practice location:
  • Phone: 951-580-1026
  • Fax:
Mailing address:
  • Phone: 951-580-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: