MEDICARE: JESSICA BAGANO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1821540857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BAGANO

Provider Business Mailing Address
First Line	:	9738 LINCOLN VILLAGE DRIVE
Second Line	:	100
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95827
Country	:	US
Telephone Number	:	916-583-4492
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 V STREET
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817
Country	:	US
Telephone Number	:	916-583-4492
Fax Number	:

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

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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