Healthcare Provider Details

I. General information

NPI: 1487449716
Provider Name (Legal Business Name): JESSICA CILEO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N GRANT LN
FOLSOM CA
95630-2139
US

IV. Provider business mailing address

173 N GRANT LN
FOLSOM CA
95630-2139
US

V. Phone/Fax

Practice location:
  • Phone: 562-881-6152
  • Fax:
Mailing address:
  • Phone: 562-881-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86343263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: