Healthcare Provider Details

I. General information

NPI: 1225456346
Provider Name (Legal Business Name): JASEN DAYO OKUNNUGA PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ESCUELA AVE
MOUNTAIN VIEW CA
94040-2006
US

IV. Provider business mailing address

1400 MONTECITO AVE
MOUNTAIN VIEW CA
94043-4590
US

V. Phone/Fax

Practice location:
  • Phone: 650-526-7535
  • Fax:
Mailing address:
  • Phone: 650-526-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220154358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: