Healthcare Provider Details

I. General information

NPI: 1497013981
Provider Name (Legal Business Name): JACQUILINE BRAZIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9862 TRAVELER CT
ELK GROVE CA
95624-4724
US

IV. Provider business mailing address

9862 TRAVELER CT
ELK GROVE CA
95624-4724
US

V. Phone/Fax

Practice location:
  • Phone: 347-845-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: