Healthcare Provider Details

I. General information

NPI: 1609657956
Provider Name (Legal Business Name): JESSICA JESSENIA VILLALOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 EL CAJON BLVD STE 14
SAN DIEGO CA
92115-3918
US

IV. Provider business mailing address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

V. Phone/Fax

Practice location:
  • Phone: 619-640-3266
  • Fax:
Mailing address:
  • Phone: 408-284-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: