=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407534142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA T MARTINEZ CONTRERAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2023
-----------------------------------------------------
Last Update Date | 08/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10824 OLSON DR STE C
-----------------------------------------------------
City | RANCHO CORDOVA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-5651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-411-2282
-----------------------------------------------------
Fax | 916-242-7568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26010 GADING RD APT 1
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94544-3286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-978-1932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-24-347313
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------