Provider Demographics
NPI:1598542110
Name:DE CARO, JEANETTE (BCHN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:DE CARO
Suffix:
Gender:F
Credentials:BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14873 AMBER GROVE CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7070
Mailing Address - Country:US
Mailing Address - Phone:916-316-0858
Mailing Address - Fax:
Practice Address - Street 1:14873 AMBER GROVE CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7070
Practice Address - Country:US
Practice Address - Phone:916-316-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5399171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach