Provider Demographics
NPI:1992210850
Name:IZQUIERDO, JESSICA DEYANIRA (RAD TECH)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DEYANIRA
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:RAD TECH
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:DEYANIRA
Other - Last Name:IZQUIERDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CT TECH
Mailing Address - Street 1:8233 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-4530
Mailing Address - Country:US
Mailing Address - Phone:916-548-0230
Mailing Address - Fax:
Practice Address - Street 1:8233 SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4530
Practice Address - Country:US
Practice Address - Phone:916-548-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF000877582085R0202X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology