Provider Demographics
NPI:1518599695
Name:BADILLO, JAHAIRA SOLEDAD
Entity Type:Individual
Prefix:
First Name:JAHAIRA
Middle Name:SOLEDAD
Last Name:BADILLO
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 1:2303 W JAY ST APT F
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3364
Mailing Address - Country:US
Mailing Address - Phone:323-697-8852
Mailing Address - Fax:
Practice Address - Street 1:2303 W JAY ST APT F
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3364
Practice Address - Country:US
Practice Address - Phone:323-697-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty