Wanda Mercedes Jackson

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1069 Broadway Ave Ste 201
Seaside, CA 93955-4995

Phone

(831) 392-1500

NPI assigned

Mar 30, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Wanda Mercedes Tineo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Village Project, Inc

  • Health Maintenance Organization
  • Seaside, CA
  • NPI 1205138765
  NPD (past)
• The Village Project, Incorporated

  • Community/Behavioral Health Agency
  • Seaside, CA
  • NPI 1073758249
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1497287338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 BROADWAY AVE",
            "city": "SEASIDE",
            "state": "CA",
            "postal_code": "939554996",
            "telephone_number": "831-392-1500",
            "fax_number": "831-392-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 BROADWAY AVE STE 201",
            "city": "SEASIDE",
            "state": "CA",
            "postal_code": "939554995",
            "telephone_number": "831-392-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WANDA",
        "middle_name": "MERCEDES",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "TINEO",
            "middle_name": "MERCEDES",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julia Ingle, PT, DPT
• Alexandria Ingram
• Lekesha Ingram
• International School of Monterey
• Linden Kazuo Ishii, DDS
• Harry K Jang, MD
• JDT Consultants, Inc.
• Morgan Epperson Jealous
• Georgina C. Jimenez
• Cynthia Jodlowski-Mendoza, PPS

• Counselor in Seaside, CA
• Providers in Seaside, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.