=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083106785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JESSICA MARIE RAYGOZA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4441 AUBURN BLVD STE E
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95841-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-473-5764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9121 FOLSOM BLVD STE F
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-2473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-491-1351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | RA9860620
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------