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General NPI Number Information
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NPI Number | 1407295454
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Entity Type | Individual
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Provider Name | JAMIE RODERICK PASCUAL PSYCH TECH
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Gender | Male
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 815 TOBIN DR
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City | VALLEJO
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State | CA
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Zip | 94589-1676
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Country | US
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Telephone | 707-280-5734
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Fax | 707-648-3360
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Provider Business Mailing Address
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Address Line | 815 TOBIN DR
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City | VALLEJO
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State | CA
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Zip | 94589-1676
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Country | US
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Telephone | 707-280-5734
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Fax | 707-648-3360
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 33560
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License Number State | CA
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