Healthcare Provider Details

I. General information

NPI: 1114218252
Provider Name (Legal Business Name): JESSICA M ABREU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CORSON ST APT 103
PASADENA CA
91103-3857
US

IV. Provider business mailing address

160 CORSON ST APT 103
PASADENA CA
91103-3857
US

V. Phone/Fax

Practice location:
  • Phone: 347-596-1553
  • Fax: 323-319-3996
Mailing address:
  • Phone: 347-596-1553
  • Fax: 323-319-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405400
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95184980
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028184
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number640322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: