Provider Demographics
NPI:1326648684
Name:NAZARIO, JACOBETH (PSYD)
Entity Type:Individual
Prefix:
First Name:JACOBETH
Middle Name:
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4203
Mailing Address - Country:US
Mailing Address - Phone:760-607-7257
Mailing Address - Fax:877-912-4883
Practice Address - Street 1:3702 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4203
Practice Address - Country:US
Practice Address - Phone:760-607-7257
Practice Address - Fax:877-912-4883
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical