Healthcare Provider Details

I. General information

NPI: 1245479633
Provider Name (Legal Business Name): JESSICA REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA JENSEN

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

1800 HARRISON ST 7TH FLOOR
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7719
  • Fax: 916-973-6354
Mailing address:
  • Phone: 510-625-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: