Healthcare Provider Details

I. General information

NPI: 1396394490
Provider Name (Legal Business Name): PRINCESS JARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR BLDG B
NAPA CA
94558-6216
US

IV. Provider business mailing address

2751 NAPA VALLEY CORPORATE DR BLDG B
NAPA CA
94558-6216
US

V. Phone/Fax

Practice location:
  • Phone: 707-227-3900
  • Fax:
Mailing address:
  • Phone: 707-227-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number35954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: