Healthcare Provider Details

I. General information

NPI: 1134698483
Provider Name (Legal Business Name): JESSICA DOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD STE 100
WALNUT CREEK CA
94597-2078
US

IV. Provider business mailing address

3824 BUELL ST STE A2
OAKLAND CA
94619-2861
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3959
  • Fax:
Mailing address:
  • Phone: 510-422-3959
  • Fax: 510-422-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: