MEDICARE: LOUISA VICTORIA JACQUEZ MS

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1952831265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISA VICTORIA JACQUEZ MS

Provider Business Mailing Address
First Line	:	703 LOS HUECOS DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4634
Country	:	US
Telephone Number	:	408-599-6013
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 LOS HUECOS DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4634
Country	:	US
Telephone Number	:	408-599-6013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	09/18/2023

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