Healthcare Provider Details

I. General information

NPI: 1114600244
Provider Name (Legal Business Name): JAZMYNE MONE MOSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MERIDIAN AVE STE 302
SAN JOSE CA
95125-5350
US

IV. Provider business mailing address

505 SAN MARIN DR STE B100
NOVATO CA
94945-1361
US

V. Phone/Fax

Practice location:
  • Phone: 628-587-7297
  • Fax:
Mailing address:
  • Phone: 628-250-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: