Provider Demographics
NPI:1962192088
Name:MARES, JULIAN E
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:E
Last Name:MARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 EVANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1822
Mailing Address - Country:US
Mailing Address - Phone:626-723-5153
Mailing Address - Fax:
Practice Address - Street 1:1015 EVANWOOD AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1822
Practice Address - Country:US
Practice Address - Phone:626-723-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician