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General NPI Number Information
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NPI Number | 1578379277
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Entity Type | Individual
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Provider Name | JESSICA DANIELLE RICHARDSON NP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 9888 CARROLL CENTRE RD STE 218A
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City | SAN DIEGO
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State | CA
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Zip | 92126-4515
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Country | US
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Telephone | 858-935-9104
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 FLORINE DR APT B
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City | LEMON GROVE
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State | CA
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Zip | 91945-2119
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Country | US
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Telephone | 636-448-9339
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032874
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License Number State | CA
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