Provider Demographics
NPI:1265317119
Name:JACQUEZ, MARIA G (PPS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:JACQUEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 DAGGETT WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1924
Mailing Address - Country:US
Mailing Address - Phone:916-606-4527
Mailing Address - Fax:
Practice Address - Street 1:508 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2555
Practice Address - Country:US
Practice Address - Phone:916-375-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210169980101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool