Provider Demographics
NPI:1336635663
Name:CUCCIA, JADE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ELIZABETH
Last Name:CUCCIA
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 1:226 BONTA ST # 121
Mailing Address - Street 2:
Mailing Address - City:BLAIRSDEN
Mailing Address - State:CA
Mailing Address - Zip Code:96103-9000
Mailing Address - Country:US
Mailing Address - Phone:530-737-9622
Mailing Address - Fax:
Practice Address - Street 1:226 BONTA ST
Practice Address - Street 2:
Practice Address - City:BLAIRSDEN
Practice Address - State:CA
Practice Address - Zip Code:96103-9000
Practice Address - Country:US
Practice Address - Phone:530-737-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X
CA00997122376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide