=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336625821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN KENNETH CHECA FERNANDEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2018
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 GREAT AMERICA PKWY STE 320
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-205-7088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 CAYUGA AVE RM 156
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94112-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-469-4512
-----------------------------------------------------
Fax | 415-337-2175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 19386
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------