Healthcare Provider Details

I. General information

NPI: 1295100675
Provider Name (Legal Business Name): KRYSTAL KUPAAKAMANAO JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1-CROW CANYON CT. STE # 100
SAN RAMON CA
94583
US

IV. Provider business mailing address

10205 LONGFELLOW AVE
OAKLAND CA
94603-3441
US

V. Phone/Fax

Practice location:
  • Phone: 888-531-8385
  • Fax: 925-264-1902
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: