Provider Demographics
NPI:1205361391
Name:CIMOLINO, JESSICA MICHELLE AGUINALDO (HAD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE AGUINALDO
Last Name:CIMOLINO
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:AGUINALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAD
Mailing Address - Street 1:103 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5401
Mailing Address - Country:US
Mailing Address - Phone:707-962-9230
Mailing Address - Fax:
Practice Address - Street 1:103 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5401
Practice Address - Country:US
Practice Address - Phone:707-962-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7935237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist