Healthcare Provider Details

I. General information

NPI: 1356698997
Provider Name (Legal Business Name): JAIME VERNAZZA CATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MANOR PLZ
PACIFICA CA
94044-1839
US

IV. Provider business mailing address

316 ROCKWOOD DR
SOUTH SAN FRANCISCO CA
94080-5843
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-8787
  • Fax:
Mailing address:
  • Phone: 650-888-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3195-I
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: