Healthcare Provider Details

I. General information

NPI: 1760352694
Provider Name (Legal Business Name): MRS. MARCELA CRISTINA AMEZCUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36700 SAN PEDRO DR
FREMONT CA
94536-6406
US

IV. Provider business mailing address

36700 SAN PEDRO DR
FREMONT CA
94536-6406
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240100650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: