Most Relevant Information
Provider Data
| NPI Number: | 1003365180 |
| Provider Name: | EVANGELINA JACY |
| Entity Type: | Individual |
| Taxonomy Code: | 310400000X |
| Specialty: | Assisted Living Facility |
| License Number: | 435201652 |
Most Important Dates
| Enumeration Date: | 09/29/2016 |
| Last Updated: | 09/29/2016 |
Provider Practice Location
1820 BETHANY AVE
SAN JOSE
CA
951321514
Practice Location Phone/Fax
| Phone: | 4082502568 |
| Fax: | 4087293282 |
Provider Mailing Location
1824 BETHANY AVE
SAN JOSE
CA
951321514
Provider Mailing Phone/Fax
| Phone: | 4082502568 |
| Fax: | 4087293282 |