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General NPI Number Information
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NPI Number | 1851915748
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Entity Type | Individual
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Provider Name | EUGENE N/A JACQUEZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 2120 E HILL ST UNIT 105
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City | SIGNAL HILL
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State | CA
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Zip | 90755-3761
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Country | US
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Telephone | 303-908-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 E HILL ST UNIT 105
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City | SIGNAL HILL
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State | CA
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Zip | 90755-3761
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Country | US
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Telephone | 303-908-0213
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 200019205
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License Number State | CA
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