Provider Demographics
NPI:1831474055
Name:SIEBENTHAL, JACQUELINE (RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SIEBENTHAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2316
Mailing Address - Country:US
Mailing Address - Phone:760-839-7932
Mailing Address - Fax:760-839-7978
Practice Address - Street 1:1574 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2316
Practice Address - Country:US
Practice Address - Phone:760-839-7932
Practice Address - Fax:760-839-7978
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist