Provider Demographics
NPI:1528443488
Name:BACA, JACQUELINE NOELLE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NOELLE
Last Name:BACA
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 1:102 WHEELOCK RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9719
Mailing Address - Country:US
Mailing Address - Phone:831-768-0941
Mailing Address - Fax:
Practice Address - Street 1:102 WHEELOCK RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-9719
Practice Address - Country:US
Practice Address - Phone:831-768-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health