Provider Demographics
NPI:1053063321
Name:JEAN PIERRE, SAMILA
Entity Type:Individual
Prefix:
First Name:SAMILA
Middle Name:
Last Name:JEAN PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631277
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1277
Mailing Address - Country:US
Mailing Address - Phone:916-472-9854
Mailing Address - Fax:916-415-0120
Practice Address - Street 1:4200 ROCKLIN RD STE 11B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2860
Practice Address - Country:US
Practice Address - Phone:916-472-9854
Practice Address - Fax:916-415-0120
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician