Provider Demographics
NPI:1891357463
Name:JAUREGUI, LOLLBEJ
Entity Type:Individual
Prefix:MRS
First Name:LOLLBEJ
Middle Name:
Last Name:JAUREGUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOLLBEJ JAUREGUI
Mailing Address - Street 2:3813 ANNA LEE COURT
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356
Mailing Address - Country:US
Mailing Address - Phone:209-422-8229
Mailing Address - Fax:
Practice Address - Street 1:3813 ANNA LEE CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0803
Practice Address - Country:US
Practice Address - Phone:209-422-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst