Provider Demographics
NPI:1427897370
Name:CERDA, JESSICA ROCHELLE ANN
Entity type:Individual
Prefix:
First Name:JESSICA ROCHELLE
Middle Name:ANN
Last Name:CERDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA ROCHELLE
Other - Middle Name:ANN
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3520 E SHIELDS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6923
Mailing Address - Country:US
Mailing Address - Phone:559-538-1230
Mailing Address - Fax:
Practice Address - Street 1:784 W HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4800
Practice Address - Country:US
Practice Address - Phone:559-538-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker