Healthcare Provider Details

I. General information

NPI: 1265317119
Provider Name (Legal Business Name): MARIA G JACQUEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 POPLAR AVE
WEST SACRAMENTO CA
95691-2555
US

IV. Provider business mailing address

1731 DAGGETT WAY
SACRAMENTO CA
95835-1924
US

V. Phone/Fax

Practice location:
  • Phone: 916-375-7720
  • Fax:
Mailing address:
  • Phone: 916-606-4527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210169980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: