Healthcare Provider Details

I. General information

NPI: 1962177642
Provider Name (Legal Business Name): MARIA JOSE JARQUIN-GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 MERCED ST
SAN LEANDRO CA
94577-4228
US

IV. Provider business mailing address

1534 PLAZA LN # 154
BURLINGAME CA
94010-3204
US

V. Phone/Fax

Practice location:
  • Phone: 510-346-2463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: