Provider Demographics
NPI:1366525768
Name:XAVIER, JACQUELINE MARIA (MMS PAC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIA
Last Name:XAVIER
Suffix:
Gender:F
Credentials:MMS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 PIERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3871
Mailing Address - Country:US
Mailing Address - Phone:714-821-0626
Mailing Address - Fax:
Practice Address - Street 1:7601 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-401-6074
Practice Address - Fax:562-401-6247
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant