Healthcare Provider Details

I. General information

NPI: 1245631670
Provider Name (Legal Business Name): JACQUELYN FRANCISCO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 12/10/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24863 W JAYNE AVE
COALINGA CA
93210-9502
US

IV. Provider business mailing address

PO BOX 770
LEMOORE CA
93245-0770
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2014031006
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: