Provider Demographics
NPI:1467279745
Name:ANTIPUESTO, JESSICA-MICHAELLA ALVAREZ
Entity type:Individual
Prefix:
First Name:JESSICA-MICHAELLA
Middle Name:ALVAREZ
Last Name:ANTIPUESTO
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:JESSICA-MICHAELLA
Other - Middle Name:ALVAREZ
Other - Last Name:PERPETUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9412 BIG HORN BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9412 BIG HORN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1101
Practice Address - Country:US
Practice Address - Phone:916-609-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion