Provider Demographics
NPI:1548031578
Name:JUAREZ, LIZETTE
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name: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 1:14148 MAGNOLIA BLVD. , CA
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SHERMAN OAKS,
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14148 MAGNOLIA BLVD. , CA
Practice Address - Street 2:SUITE #103
Practice Address - City:SHERMAN OAKS,
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:310-649-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician