Healthcare Provider Details

I. General information

NPI: 1023933744
Provider Name (Legal Business Name): MAKAYLA JAZZLYN NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2001 GATEWAY PL # 230
SAN JOSE CA
95110-1010
US

IV. Provider business mailing address

350 TWIN DOLPHIN DR STE 109
REDWOOD CITY CA
94065-1458
US

V. Phone/Fax

Practice location:
  • Phone: 408-441-0740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: