Healthcare Provider Details

I. General information

NPI: 1578006466
Provider Name (Legal Business Name): JENNIFER EFEMENA OZOMARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 3RD ST
SAN FRANCISCO CA
94124-3101
US

IV. Provider business mailing address

369 STANYAN ST APT. 6
SAN FRANCISCO CA
94118-4273
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-7500
  • Fax:
Mailing address:
  • Phone: 415-822-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number95855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: