Provider Demographics
NPI:1548446784
Name:SEFIANE, JERRY JACOB (MA)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:JACOB
Last Name:SEFIANE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13899 DOVE CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2272
Mailing Address - Country:US
Mailing Address - Phone:909-803-2727
Mailing Address - Fax:
Practice Address - Street 1:13899 DOVE CANYON WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2272
Practice Address - Country:US
Practice Address - Phone:909-803-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator