Healthcare Provider Details

I. General information

NPI: 1477407104
Provider Name (Legal Business Name): JESSICA DANIELLE AVINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E BROWNING AVE
FRESNO CA
93710-6108
US

IV. Provider business mailing address

890 S 10TH ST BLDG C
FRESNO CA
93702-3506
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-4550
  • Fax:
Mailing address:
  • Phone: 559-451-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: