Healthcare Provider Details

I. General information

NPI: 1275279838
Provider Name (Legal Business Name): JACQUELINE SOLIS RESENDIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E MAIN ST
TURLOCK CA
95380-4521
US

IV. Provider business mailing address

1618 SCENIC DR
MODESTO CA
95355-4908
US

V. Phone/Fax

Practice location:
  • Phone: 209-424-0590
  • Fax:
Mailing address:
  • Phone: 209-404-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: