Provider Demographics
NPI:1790530400
Name:TIONGCO, JESCELLE III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESCELLE
Middle Name:
Last Name:TIONGCO
Suffix:III
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 VALLEY RIM GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3842
Mailing Address - Country:US
Mailing Address - Phone:760-807-7352
Mailing Address - Fax:
Practice Address - Street 1:2159 VALLEY RIM GLN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3842
Practice Address - Country:US
Practice Address - Phone:760-807-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist