Healthcare Provider Details

I. General information

NPI: 1558936351
Provider Name (Legal Business Name): JESSICA GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W ORANGE AVE STE 105
ANAHEIM CA
92804-3152
US

IV. Provider business mailing address

1320 W PEARL ST
ANAHEIM CA
92801-5941
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-8277
  • Fax:
Mailing address:
  • Phone: 714-780-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: