Healthcare Provider Details

I. General information

NPI: 1164126421
Provider Name (Legal Business Name): MARIA JOSE JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 SUTTER ST STE 405
SAN FRANCISCO CA
94108-4618
US

IV. Provider business mailing address

8360 DELCO AVE
WINNETKA CA
91306-1315
US

V. Phone/Fax

Practice location:
  • Phone: 415-992-6155
  • Fax:
Mailing address:
  • Phone: 818-590-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: