Provider Demographics
NPI:1194479634
Name:JACQUILLON, CLAUDIA
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:JACQUILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:
Other - Last Name:CAUSILLAS CORBELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3997 MILTON TER # 3997
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2246
Mailing Address - Country:US
Mailing Address - Phone:510-396-4072
Mailing Address - Fax:
Practice Address - Street 1:3997 MILTON TER # 3997
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2246
Practice Address - Country:US
Practice Address - Phone:510-396-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician