Provider Demographics
NPI:1790383503
Name:OCEGUEDA, JESSICA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:OCEGUEDA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2520
Mailing Address - Country:US
Mailing Address - Phone:209-814-5239
Mailing Address - Fax:
Practice Address - Street 1:326 W 21ST ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2520
Practice Address - Country:US
Practice Address - Phone:209-814-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist