Healthcare Provider Details

I. General information

NPI: 1538585609
Provider Name (Legal Business Name): JENNIFER PRECIADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 ELM AVE
LONG BEACH CA
90802-2426
US

IV. Provider business mailing address

10459 ARTESIA BLVD APT 89C
BELLFLOWER CA
90706-7916
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-6717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT37212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: