Provider Demographics
NPI:1306156146
Name:GITMAN, JACQUELINE S
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:GITMAN
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 1:691 FIR ST
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4532
Mailing Address - Country:US
Mailing Address - Phone:530-876-9511
Mailing Address - Fax:530-872-1056
Practice Address - Street 1:691 FIR ST
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4532
Practice Address - Country:US
Practice Address - Phone:530-876-9511
Practice Address - Fax:530-872-1056
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist