Healthcare Provider Details

I. General information

NPI: 1316762008
Provider Name (Legal Business Name): JESSICA HAZEL LOUIE RN, NP
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JESSICA HAZEL PURDIN RN, NP

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33456 ALVARADO NILES RD
UNION CITY CA
94587-3110
US

IV. Provider business mailing address

21019 BAKER RD APT 2
CASTRO VALLEY CA
94546-5763
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-0600
  • Fax:
Mailing address:
  • Phone: 858-232-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95368801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number95368801
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95368801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: