Individual
EUGENE N/A JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2120 E HILL ST UNIT 105, SIGNAL HILL, CA 90755-3761
(303) 908-0213
Mailing address
2120 E HILL ST UNIT 105, SIGNAL HILL, CA 90755-3761
(303) 908-0213
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
200019205
CA
103TS0200X
School Psychologist
—
CA
Other
Enumeration date
06/05/2020
Last updated
06/05/2020
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