Healthcare Provider Details

I. General information

NPI: 1104216498
Provider Name (Legal Business Name): JESSICA FERRAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 W BLAINE ST STE A
RIVERSIDE CA
92507-3970
US

IV. Provider business mailing address

769 W BLAINE ST STE A
RIVERSIDE CA
92507-3970
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4705
  • Fax:
Mailing address:
  • Phone: 951-358-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1498010223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: