Healthcare Provider Details

I. General information

NPI: 1649027954
Provider Name (Legal Business Name): JACQUELINE EISENACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4810
  • Fax: 707-565-4907
Mailing address:
  • Phone: 707-565-4810
  • Fax: 707-565-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: