MEDICARE: JESSICA GASIOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	88541	CA

General Provider Information

NPI Number	:	1750729422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GASIOR

Provider Business Mailing Address
First Line	:	1660 HOTEL CIR N
Second Line	:	SUITE 314
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2807
Country	:	US
Telephone Number	:	619-961-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 HOTEL CIR N
Second Line	:	SUITE 314
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2807
Country	:	US
Telephone Number	:	619-961-2137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	05/18/2016

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