Healthcare Provider Details

I. General information

NPI: 1578051058
Provider Name (Legal Business Name): JALEENA FANUNCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 GULL AVE
FOSTER CITY CA
94404-1354
US

IV. Provider business mailing address

18005 SUNOL RD
HAYWARD CA
94541-4631
US

V. Phone/Fax

Practice location:
  • Phone: 650-485-9837
  • Fax:
Mailing address:
  • Phone: 510-921-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12368113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: