Provider Demographics
NPI:1154071850
Name:TAUEETIA, JACQUELYN ELISA
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELISA
Last Name:TAUEETIA
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 1:2945 YORKTOWN CT
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4936
Mailing Address - Country:US
Mailing Address - Phone:831-258-5923
Mailing Address - Fax:
Practice Address - Street 1:427 PAJARO ST # 4
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3459
Practice Address - Country:US
Practice Address - Phone:831-424-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program