Healthcare Provider Details

I. General information

NPI: 1699699157
Provider Name (Legal Business Name): JACQUELINE GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ESTATES DR STE 200
ROSEVILLE CA
95678-2300
US

IV. Provider business mailing address

908 ATLANTIC ST SPC 28
ROSEVILLE CA
95678-1813
US

V. Phone/Fax

Practice location:
  • Phone: 916-769-4260
  • Fax:
Mailing address:
  • Phone: 916-769-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number77151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: