Healthcare Provider Details

I. General information

NPI: 1346155066
Provider Name (Legal Business Name): JESSICA BAEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12139 MOUNT VERNON AVE STE 210
GRAND TERRACE CA
92313-5562
US

IV. Provider business mailing address

983 OHIO ST
PORTERVILLE CA
93257-1554
US

V. Phone/Fax

Practice location:
  • Phone: 909-577-1124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number141453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: