Healthcare Provider Details

I. General information

NPI: 1396947529
Provider Name (Legal Business Name): JESSICA BUCKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 STONERIDGE DR KAISER MEDICAL OFFICE
PLEASANTON CA
94588-4501
US

IV. Provider business mailing address

7601 STONERIDGE DR KAISER MEDICAL OFFICE
PLEASANTON CA
94588-4501
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: