Healthcare Provider Details

I. General information

NPI: 1215407341
Provider Name (Legal Business Name): DR. JOSE JAVIER JUAREZ, PSY.D., CLINICAL PSYCHOLOGIST, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S PALOS VERDES ST #559
SAN PEDRO CA
90731
US

IV. Provider business mailing address

444 W OCEAN BLVD STE 800
LONG BEACH CA
90802-4529
US

V. Phone/Fax

Practice location:
  • Phone: 818-634-4783
  • Fax:
Mailing address:
  • Phone: 747-500-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE JAVIER URIZAR JUAREZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSY.D.
Phone: 818-634-4783