Healthcare Provider Details

I. General information

NPI: 1457285322
Provider Name (Legal Business Name): JENNIFER LYANN VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 BRYANT ST
SAN FRANCISCO CA
94110-1406
US

IV. Provider business mailing address

1190 MISSION ST APT 610
SAN FRANCISCO CA
94103-1674
US

V. Phone/Fax

Practice location:
  • Phone: 415-558-9125
  • Fax:
Mailing address:
  • Phone: 415-558-9125
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1040502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: