Healthcare Provider Details

I. General information

NPI: 1326953571
Provider Name (Legal Business Name): JAQUELYN MARIE BADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 14TH ST
OAKLAND CA
94607-2247
US

IV. Provider business mailing address

28488 MISSION BLVD APT 102
HAYWARD CA
94544-4924
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4700
  • Fax:
Mailing address:
  • Phone: 510-861-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: