Healthcare Provider Details

I. General information

NPI: 1063341675
Provider Name (Legal Business Name): INMACULADA JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8845 OKEECHOBEE BLVD APT 203
WEST PALM BEACH FL
33411-5123
US

IV. Provider business mailing address

8845 OKEECHOBEE BLVD APT 203
WEST PALM BEACH FL
33411-5123
US

V. Phone/Fax

Practice location:
  • Phone: 561-543-4502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: