Provider Demographics
NPI:1104701036
Name:PEDRO JUAREZ, RUTINA ISABEL
Entity type:Individual
Prefix:
First Name:RUTINA
Middle Name:ISABEL
Last Name:PEDRO JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9382 N ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2307
Mailing Address - Country:US
Mailing Address - Phone:531-541-7793
Mailing Address - Fax:
Practice Address - Street 1:9382 N ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2307
Practice Address - Country:US
Practice Address - Phone:531-541-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging