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NPI Code Detail

MEDICARE: ANNA JACQUEZ B.S.

MEDICARE: ANNA JACQUEZ B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2172V00000XCommunity Health Worker
3373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1568183317
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA JACQUEZ B.S.
Provider Business Mailing Address
First Line : 6110 GARFIELD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-2009
Country : US
Telephone Number : 916-642-7800
Fax Number : 916-244-0880
Provider Business Practice Location Address
First Line : 6110 GARFIELD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-2009
Country : US
Telephone Number : 916-642-7800
Fax Number : 916-244-0880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2022
Last Update Date : 04/22/2025

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