Provider Demographics
NPI:1629551692
Name:LUCIANO, JAZZLYN J (HIGH SCHOOL DIPOLMA)
Entity Type:Individual
Prefix:
First Name:JAZZLYN
Middle Name:J
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPOLMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 AVENIDA ENCINAS
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4372
Mailing Address - Country:US
Mailing Address - Phone:760-795-9898
Mailing Address - Fax:
Practice Address - Street 1:5140 AVENIDA ENCINAS
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4372
Practice Address - Country:US
Practice Address - Phone:760-795-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000000000000000000OtherCARD