Healthcare Provider Details

I. General information

NPI: 1881546612
Provider Name (Legal Business Name): JERELL PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

IV. Provider business mailing address

2163 ALDENGATE WAY UNIT 326
HAYWARD CA
94557-1007
US

V. Phone/Fax

Practice location:
  • Phone: 510-459-7264
  • Fax:
Mailing address:
  • Phone: 510-994-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: