Provider Demographics
NPI:1053024695
Name:PLASCENCIA, JUAN M JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:PLASCENCIA
Suffix:JR
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 1:643 GATES CT
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2718
Mailing Address - Country:US
Mailing Address - Phone:805-835-9005
Mailing Address - Fax:805-788-2724
Practice Address - Street 1:805 4TH ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3173
Practice Address - Country:US
Practice Address - Phone:805-226-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1131551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical