Healthcare Provider Details

I. General information

NPI: 1700393196
Provider Name (Legal Business Name): JENNIFER J PICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2018
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 OCEANSIDE BLVD STE T
OCEANSIDE CA
92056-5821
US

IV. Provider business mailing address

4055 OCEANSIDE BLVD STE T
OCEANSIDE CA
92056-5821
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-1793
  • Fax:
Mailing address:
  • Phone:
  • 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: