Healthcare Provider Details

I. General information

NPI: 1851228092
Provider Name (Legal Business Name): JACQUELINE ISLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

IV. Provider business mailing address

4611 HIBISCUS RD
STOCKTON CA
95212-2521
US

V. Phone/Fax

Practice location:
  • Phone: 209-988-5141
  • Fax:
Mailing address:
  • Phone: 209-244-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: