Healthcare Provider Details

I. General information

NPI: 1649156571
Provider Name (Legal Business Name): JESSICA GIMELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1705
US

IV. Provider business mailing address

4757 36TH AVE S APT 2
SEATTLE WA
98118-1772
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-7700
  • Fax:
Mailing address:
  • Phone: 916-225-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number219200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: