Michael Anthony Juan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY25664 Issued in CA

Practice address

2496 E St
#2A
San Diego, CA 92102-6208

Phone

(619) 407-9424

Fax

(888) 965-5102

NPI assigned

Mar 6, 2007

Last updated

May 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1144350315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2496 E ST",
            "address_2": "#2A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921026208",
            "telephone_number": "619-407-9424",
            "fax_number": "888-965-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2496 E ST",
            "address_2": "#2A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921026208",
            "telephone_number": "619-407-9424",
            "fax_number": "888-965-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUAN",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY25664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maluz Celeste Juache, BA
• Juan Antonio Mendoza (Abi P&O)
• Juan C. Bosque, D.D.S., Inc. (South Coast Endodontics)
• Artlynne Juan
• Ilona Catalina Juan
• Alfonso Rodriguez Juanengo, D.C.
• Noah Alexander Corpus Juanengo
• Derek K Juang, M.D.
• Patricia Shu Yu Liao Juang, M.D.
• Mary Grace Juanta

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.