Healthcare Provider Details

I. General information

NPI: 1912308032
Provider Name (Legal Business Name): MRS. JESSICA MAGDALENO GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 14TH AVE
SAN FRANCISCO CA
94118-3502
US

IV. Provider business mailing address

639 14TH AVE
SAN FRANCISCO CA
94118-3502
US

V. Phone/Fax

Practice location:
  • Phone: 415-689-5662
  • Fax: 415-668-6388
Mailing address:
  • Phone: 415-689-5662
  • Fax: 415-668-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: