Provider Demographics
NPI:1881140770
Name:KIDIO, JOCELIA JUAH
Entity type:Individual
Prefix:
First Name:JOCELIA
Middle Name:JUAH
Last Name:KIDIO
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 1:1865 HOTEL CIR S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3319
Mailing Address - Country:US
Mailing Address - Phone:619-712-9117
Mailing Address - Fax:858-292-0322
Practice Address - Street 1:1865 HOTEL CIR S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3319
Practice Address - Country:US
Practice Address - Phone:619-712-9117
Practice Address - Fax:858-292-0322
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA880391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health