Provider Demographics
NPI:1720495310
Name:SPERA, JACQUELINE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:SPERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:ROBIDOUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51555 MONROE ST SPC 40
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-9734
Mailing Address - Country:US
Mailing Address - Phone:760-347-7000
Mailing Address - Fax:760-347-7006
Practice Address - Street 1:51555 MONROE ST SPC 40
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-9734
Practice Address - Country:US
Practice Address - Phone:760-347-7000
Practice Address - Fax:760-347-7006
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information