Provider Demographics
NPI:1528600368
Name:PAVAO, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:PAVAO
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 1:35 E 10TH ST STE I
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4070
Mailing Address - Country:US
Mailing Address - Phone:510-782-0950
Mailing Address - Fax:510-782-0970
Practice Address - Street 1:333 ESTUDILLO AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4717
Practice Address - Country:US
Practice Address - Phone:510-782-0950
Practice Address - Fax:510-782-0970
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty