Provider Demographics
NPI:1114725157
Name:ENCISO, JOSE JR
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:ENCISO
Suffix:JR
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:ENCISO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:APCC
Mailing Address - Street 1:1321 SPRING VALLE PKWY
Mailing Address - Street 2:#203
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:442-327-9151
Mailing Address - Fax:
Practice Address - Street 1:14463 WELSH CT
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-7752
Practice Address - Country:US
Practice Address - Phone:909-528-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14318101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor