Provider Demographics
NPI:1073968160
Name:JARAMILLO, KITCIA DAENA (MS)
Entity Type:Individual
Prefix:
First Name:KITCIA
Middle Name:DAENA
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 CARNELIAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1157
Mailing Address - Country:US
Mailing Address - Phone:951-281-1557
Mailing Address - Fax:
Practice Address - Street 1:7365 CARNELIAN ST STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1157
Practice Address - Country:US
Practice Address - Phone:951-281-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT105215101YM0800X
CALMFT132028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health