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NPI Code Detail

MEDICARE: JESSENIA MARIE MACIEL

MEDICARE: JESSENIA MARIE MACIEL
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1750212775
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSENIA MARIE MACIEL
Provider Business Mailing Address
First Line : 7125 ALOE CT
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91739-1829
Country : US
Telephone Number : 909-319-4441
Fax Number :
Provider Business Practice Location Address
First Line : 4422 3RD AVE
Second Line :
City : BRONX
State : NY
Zip : 10457-2594
Country : US
Telephone Number : 711-860-6619
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ JESSENIA MARIE MACIEL ” Practice Location

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