Provider Demographics
NPI:1376935619
Name:CEJA, JAZMIN (BACHELOR OF ARTS)
Entity Type:Individual
Prefix:MS
First Name:JAZMIN
Middle Name:
Last Name:CEJA
Suffix:
Gender:F
Credentials:BACHELOR OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2026
Mailing Address - Country:US
Mailing Address - Phone:209-468-9637
Mailing Address - Fax:209-468-9633
Practice Address - Street 1:445 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2026
Practice Address - Country:US
Practice Address - Phone:209-468-9637
Practice Address - Fax:209-468-9633
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator