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General NPI Number Information
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NPI Number | 1780570994
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Entity Type | Individual
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Provider Name | JESSICA LYNN CROCKETT MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 700 LAWRENCE EXPY
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City | SANTA CLARA
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State | CA
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Zip | 95051-5173
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Country | US
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Telephone | 408-851-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 396 1ST ST UNIT 2
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City | LOS ALTOS
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State | CA
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Zip | 94022-3660
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Country | US
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Telephone | 916-200-9474
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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