Provider Demographics
NPI:1922256635
Name:THEM, JACQUELINE DEVERA (RCP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DEVERA
Last Name:THEM
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 SAN JUAN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1639
Mailing Address - Country:US
Mailing Address - Phone:619-346-5855
Mailing Address - Fax:
Practice Address - Street 1:10002 SAN JUAN ST APT 4
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1639
Practice Address - Country:US
Practice Address - Phone:619-346-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000271912278E1000X, 2279E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducational