Healthcare Provider Details

I. General information

NPI: 1760315485
Provider Name (Legal Business Name): CALIFORNIA CENTER FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 LELAND AVE UNIT 34532
SAN FRANCISCO CA
94134-2868
US

IV. Provider business mailing address

68 LELAND AVE UNIT 34532
SAN FRANCISCO CA
94134-2868
US

V. Phone/Fax

Practice location:
  • Phone: 833-771-1888
  • Fax:
Mailing address:
  • Phone: 833-771-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER FERNANDEZ
Title or Position: FOUNDER/CLINICAL DIRECTOR
Credential: PHD
Phone: 833-771-1888