Healthcare Provider Details

I. General information

NPI: 1477285526
Provider Name (Legal Business Name): JESSICA CINDAL NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 CHAPMAN AVE
GARDEN GROVE CA
92840-4414
US

IV. Provider business mailing address

5675 W OLYMPIC BLVD
LOS ANGELES CA
90036-4712
US

V. Phone/Fax

Practice location:
  • Phone: 855-588-1422
  • Fax:
Mailing address:
  • Phone: 323-965-1365
  • Fax: 323-965-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT142432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: