Healthcare Provider Details

I. General information

NPI: 1275303067
Provider Name (Legal Business Name): JACQUELYN PIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 SAN FRANCISCO ST
MERCED CA
95348-4802
US

IV. Provider business mailing address

3542 SAN FRANCISCO ST
MERCED CA
95348-4802
US

V. Phone/Fax

Practice location:
  • Phone: 209-600-1688
  • Fax:
Mailing address:
  • Phone: 209-600-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: