Individual
MARIA CRISSELDA JUAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11859 W CRESTED BUTTE CT, NAMPA, ID 83651-8164
(208) 957-3294
Mailing address
11859 W CRESTED BUTTE CT, NAMPA, ID 83651-8164
(208) 957-3294
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
ID
Enumeration date
10/07/2020
Last updated
10/07/2020
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