MEDICARE: SYDNEY RAE JEFFCOAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1285930115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY RAE JEFFCOAT

Provider Business Mailing Address
First Line	:	343 S 8TH ST
Second Line	:	STE. A
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2903
Country	:	US
Telephone Number	:	760-353-6151
Fax Number	:	760-353-6152

Provider Business Practice Location Address
First Line	:	343 S 8TH ST
Second Line	:	STE. A
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2903
Country	:	US
Telephone Number	:	760-353-6151
Fax Number	:	760-353-6152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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