1124803705 NPI number — MRS. JACQUE MARIE RICCI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124803705 NPI number — MRS. JACQUE MARIE RICCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICCI
Provider First Name:
JACQUE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUIRE
Provider Other First Name:
JACQUE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124803705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1591
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96020-1591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-864-2775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHESTER JR SR HIGH SCHOOL
Provider Second Line Business Practice Location Address:
612 FIRST ST.
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-258-2126
Provider Business Practice Location Address Fax Number:
530-258-2306
Provider Enumeration Date:
08/30/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)