Healthcare Provider Details

I. General information

NPI: 1073311965
Provider Name (Legal Business Name): JOSE MANUEL FELICIANO JR. AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 SARANAC ST APT 5
LA MESA CA
91942-8967
US

IV. Provider business mailing address

4443 30TH ST, SAN DIEGO, CA 92116
SAN DIEGO CA
92116
US

V. Phone/Fax

Practice location:
  • Phone: 510-415-9361
  • Fax: 510-415-9361
Mailing address:
  • Phone: 619-579-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125649
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: