Provider Demographics
NPI:1033673413
Name:PARDILLA, JESSIE PICAZO
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:PICAZO
Last Name:PARDILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 NELSON CT
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2820
Mailing Address - Country:US
Mailing Address - Phone:650-580-9262
Mailing Address - Fax:
Practice Address - Street 1:78 NELSON CT
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2820
Practice Address - Country:US
Practice Address - Phone:650-580-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9740227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered