Healthcare Provider Details

I. General information

NPI: 1730435181
Provider Name (Legal Business Name): JESSIKA FRUCHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST
OAKLAND CA
94601-3424
US

IV. Provider business mailing address

2411 10TH ST
BERKELEY CA
94710-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-370-7209
  • Fax:
Mailing address:
  • Phone: 415-370-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 78010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: