Provider Demographics
NPI:1730323643
Name:PIOCH, JACQUELINE BRIDGET (IDC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BRIDGET
Last Name:PIOCH
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 LEAHY LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6437
Mailing Address - Country:US
Mailing Address - Phone:808-265-8552
Mailing Address - Fax:
Practice Address - Street 1:NMCB SEVEN
Practice Address - Street 2:BLDG 309, UNIT 60418
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34099-5073
Practice Address - Country:US
Practice Address - Phone:228-871-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman