Provider Demographics
NPI:1730879735
Name:HUMILDAD, JESSICA JAZMINE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAZMINE
Last Name:HUMILDAD
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 1:118 W ALVIN DR APT B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-8374
Mailing Address - Country:US
Mailing Address - Phone:831-320-1721
Mailing Address - Fax:
Practice Address - Street 1:118 W ALVIN DR APT B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-8374
Practice Address - Country:US
Practice Address - Phone:831-320-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2273963172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver