Provider Demographics
NPI:1245582725
Name:JERNEJCIC, CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:JERNEJCIC
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 1:22698 SPRINGMIST DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2698
Mailing Address - Country:US
Mailing Address - Phone:909-419-9829
Mailing Address - Fax:
Practice Address - Street 1:950 N RAMONA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-2567
Practice Address - Country:US
Practice Address - Phone:951-487-2674
Practice Address - Fax:951-487-2679
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker