Basic Information
| Provider Information | |||||||||
| NPI: | 1225142276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIO | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CADC II | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JIO | ||||||||
| OtherFirstName: | ROCKY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7225 EAST SOUTHGATE DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163941000 | ||||||||
| FaxNumber: | 9163941010 | ||||||||
| Practice Location | |||||||||
| Address1: | 7225 EAST SOUTHGATE DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163941000 | ||||||||
| FaxNumber: | 9163941010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A8514606 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.