Healthcare Provider Details

I. General information

NPI: 1730827742
Provider Name (Legal Business Name): BRET DAVIS JESKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 RED HILL AVE STE A200
COSTA MESA CA
92626-7978
US

IV. Provider business mailing address

1560 BROOKHOLLOW DR STE 214
SANTA ANA CA
92705-5411
US

V. Phone/Fax

Practice location:
  • Phone: 650-663-4978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: