Provider Demographics
NPI:1245805647
Name:BAPTISTA, JESSICA ARLENE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARLENE
Last Name:BAPTISTA
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 1:817 DOYLE AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2530
Mailing Address - Country:US
Mailing Address - Phone:909-557-8830
Mailing Address - Fax:
Practice Address - Street 1:817 DOYLE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2530
Practice Address - Country:US
Practice Address - Phone:909-557-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty