Provider Demographics
NPI:1376105569
Name:SINGH, JACQUELINE JOYTISHNA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOYTISHNA
Last Name:SINGH
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 1:2480 WEXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5515
Mailing Address - Country:US
Mailing Address - Phone:415-304-0073
Mailing Address - Fax:
Practice Address - Street 1:2480 WEXFORD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5515
Practice Address - Country:US
Practice Address - Phone:415-304-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician