Healthcare Provider Details

I. General information

NPI: 1205322328
Provider Name (Legal Business Name): JESSICA HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ATLANTIC AVE STE 101
ALAMEDA CA
94501-1188
US

IV. Provider business mailing address

511 SUMMER LN
SAN PABLO CA
94806-2193
US

V. Phone/Fax

Practice location:
  • Phone: 510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00006275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: