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General NPI Number Information
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NPI Number | 1205010543
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Entity Type | Individual
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Provider Name | MARJORIE A. MOJICA-JARA DMD
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Gender | Female
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 3609 MISSION AVE SUITE B
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City | CARMICHAEL
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State | CA
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Zip | 95608-2955
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Country | US
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Telephone | 916-488-5781
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Fax | 916-488-5973
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Provider Business Mailing Address
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Address Line | 5200 STOCKTON BLVD SUITE 110
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City | SACRAMENTO
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State | CA
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Zip | 95820-5455
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Country | US
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Telephone | 916-455-6600
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Fax | 916-455-4638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D56569
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License Number State | CA
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