Provider Demographics
NPI:1114751419
Name:JEMIO, RAQUEL MARINA
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:MARINA
Last Name:JEMIO
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 1:3778 VISTA PT
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1100
Mailing Address - Country:US
Mailing Address - Phone:619-636-2688
Mailing Address - Fax:
Practice Address - Street 1:3778 VISTA PT
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1100
Practice Address - Country:US
Practice Address - Phone:619-636-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician