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General NPI Number Information
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NPI Number | 1083581011
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Entity Type | Individual
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Provider Name | JADE AZEVEDO
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Gender | Female
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 269 MOUNT HERMON RD STE 204
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City | SCOTTS VALLEY
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State | CA
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Zip | 95066-4000
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Country | US
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Telephone | 831-464-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 102 OVERLOOK DR
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT308854
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License Number State | CA
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