Provider Demographics
NPI:1093302697
Name:TRIANA, JILL JAECK
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JAECK
Last Name:TRIANA
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 1:5830 N MCCALL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8723
Mailing Address - Country:US
Mailing Address - Phone:559-285-2340
Mailing Address - Fax:
Practice Address - Street 1:5830 N MCCALL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8723
Practice Address - Country:US
Practice Address - Phone:559-285-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider