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1639684228
LARICA FANTASIA JACKO
SAN JOSE, CA
NPI
1639684228
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
171M00000X Case Manager/Care Coordinator
Enumeration Date
2017-12-05
Last Update Date
2017-12-05
Business Address
LARICA FANTASIA JACKO
1400 PARKMOOR AVE
SAN JOSE, CA 95126-3797
Phone number: 408-637-8009
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Mailing Address
LARICA FANTASIA JACKO
1400 PARKMOOR AVE
SAN JOSE, CA 95126-3797
Phone number: 408-637-8009
Copy
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