Healthcare Provider Details

I. General information

NPI: 1346119062
Provider Name (Legal Business Name): JEKARA GOVAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IXKARI MUNOZ-ESTELLE MA

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 24TH ST
RICHMOND CA
94804-1804
US

IV. Provider business mailing address

200 24TH ST
RICHMOND CA
94804-1804
US

V. Phone/Fax

Practice location:
  • Phone: 510-960-0514
  • Fax:
Mailing address:
  • Phone: 510-960-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: