Healthcare Provider Details

I. General information

NPI: 1912674920
Provider Name (Legal Business Name): JAMIE PANNOZZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 GENERAL KENNEDY AVE STE 4
SAN FRANCISCO CA
94129-1405
US

IV. Provider business mailing address

1007 GENERAL KENNEDY AVE STE 4
SAN FRANCISCO CA
94129-1405
US

V. Phone/Fax

Practice location:
  • Phone: 909-713-8744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136332
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: