Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | RBT-21-164637 | CA |
NPI | 1083295067 |
---|---|
Provider Name | Jessica Mauricio Marcos |
First Address | Sacramento, CA 95825-3221 |
Second Address | Sacramento, CA 95825-3221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 06/08/2021 |