Provider Demographics
NPI:1578326484
Name:JAQUEZ, DELILLAH MAURA
Entity Type:Individual
Prefix:
First Name:DELILLAH
Middle Name:MAURA
Last Name:JAQUEZ
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 1:1443 MARIN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3024
Mailing Address - Country:US
Mailing Address - Phone:831-809-6079
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL PARKWAY, SUITE 200
Practice Address - Street 2:LAKE MARY, FL 32746-3625
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician