Individual
MR. JEREMIAH DAVID SISCO-ASENCIO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4411 E KINGS CANYON RD # 319, FRESNO, CA 93702-3604
(559) 600-2382
Mailing address
3433 W SHAW AVE, FRESNO, CA 93711-3229
(559) 558-4051
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
225561
CA
164X00000X
Licensed Vocational Nurse
Primary
225561
CA
Other
Enumeration date
07/12/2015
Last updated
01/05/2023
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