Provider Demographics
NPI:1922897958
Name:MACEDA, JAZMINE CELESTINE
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:CELESTINE
Last Name:MACEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 BOULDER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-9109
Mailing Address - Country:US
Mailing Address - Phone:209-665-9421
Mailing Address - Fax:
Practice Address - Street 1:2603 CAMINO RAMON STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-9137
Practice Address - Country:US
Practice Address - Phone:925-678-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician