Healthcare Provider Details

I. General information

NPI: 1841078110
Provider Name (Legal Business Name): JACQUELINE HUTCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HACIENDA AVE STE B
CAMPBELL CA
95008-6625
US

IV. Provider business mailing address

221 E HACIENDA AVE STE B
CAMPBELL CA
95008-6625
US

V. Phone/Fax

Practice location:
  • Phone: 408-376-3350
  • Fax: 408-374-4130
Mailing address:
  • Phone: 408-376-3350
  • Fax: 408-374-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberPA66415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: