Healthcare Provider Details

I. General information

NPI: 1629498589
Provider Name (Legal Business Name): JESSICA ANN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 KERN AVE
SAN JOSE CA
95121-2329
US

IV. Provider business mailing address

2791 KERN AVE
SAN JOSE CA
95121-2329
US

V. Phone/Fax

Practice location:
  • Phone: 408-623-5011
  • Fax:
Mailing address:
  • Phone: 408-623-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: