Healthcare Provider Details

I. General information

NPI: 1639017148
Provider Name (Legal Business Name): JESSE ZANKO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

IV. Provider business mailing address

5421 CAMPBELL LN UNIT 429
DUBLIN CA
94568-4455
US

V. Phone/Fax

Practice location:
  • Phone: 415-233-1608
  • Fax:
Mailing address:
  • Phone: 415-233-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: