Provider Demographics
NPI:1821652728
Name:OCEGUEDA, JESSE CATALINO
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:CATALINO
Last Name:OCEGUEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13826 HUMMINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5991
Mailing Address - Country:US
Mailing Address - Phone:909-251-3619
Mailing Address - Fax:
Practice Address - Street 1:13826 HUMMINGBIRD WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5991
Practice Address - Country:US
Practice Address - Phone:909-251-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty