Provider Demographics
NPI:1578608568
Name:ROJAS, JACQUELINE P (LPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:P
Last Name:ROJAS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 S MOONEY BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9535
Mailing Address - Country:US
Mailing Address - Phone:559-685-1200
Mailing Address - Fax:
Practice Address - Street 1:6500 S MOONEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9535
Practice Address - Country:US
Practice Address - Phone:559-594-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29364167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 29364OtherLPT