Healthcare Provider Details

I. General information

NPI: 1770961997
Provider Name (Legal Business Name): MRS. JESSICA PRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 HOWARD ST
SAN FRANCISCO CA
94103-2807
US

IV. Provider business mailing address

1632 141ST AVE
SAN LEANDRO CA
94578-1704
US

V. Phone/Fax

Practice location:
  • Phone: 415-226-1775
  • Fax: 415-902-8753
Mailing address:
  • Phone: 510-576-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW65419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: