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General NPI Number Information
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NPI Number | 1851790968
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Entity Type | Individual
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Provider Name | ESTEBAN JUAREZ LCSW #28425
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Gender | Male
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 3151 AIRWAY AVE STE F107
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City | COSTA MESA
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State | CA
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Zip | 92626-4623
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Country | US
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Telephone | 714-618-1583
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6100
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-6100
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Country | US
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Telephone | 949-764-5947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28425
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License Number State | CA
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