=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447936323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JESSICA RENEE DIGIORNO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 W. MORGAN ST.
-----------------------------------------------------
City | PERRIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-317-0377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3380 LA SIERRA AVE #104-533
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-317-0377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 103985
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------