Provider Demographics
NPI:1073143954
Name:JARAMILLIO MEZA, JOSEFINA
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:JARAMILLIO MEZA
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 1:5268 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3525
Mailing Address - Country:US
Mailing Address - Phone:909-536-4804
Mailing Address - Fax:
Practice Address - Street 1:5268 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3525
Practice Address - Country:US
Practice Address - Phone:909-536-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty