Active NPI
Leo Eliborio Juarez, LCSW
- Clinical Social Worker
- Upland, CA
National Provider Identifier
1972039337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS6108
- Practice address
- 1403 Alta Ave
Upland, CA 91786-2814 - Phone
- (909) 228-3028
- NPI assigned
- May 4, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS6108 | CA | Primary |
Addresses
Primary practice location
1403 Alta Ave
Upland, CA 91786-2814
Mailing address
1403 Alta Ave
Upland, CA 91786-2814
Phone (909) 228-3028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS6108 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1972039337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1403 ALTA AVE",
"city": "UPLAND",
"state": "CA",
"postal_code": "917862814",
"telephone_number": "909-228-3028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 ALTA AVE",
"city": "UPLAND",
"state": "CA",
"postal_code": "917862814",
"telephone_number": "909-228-3028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUAREZ",
"first_name": "LEO",
"middle_name": "ELIBORIO",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-04",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS6108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.