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General NPI Number Information
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NPI Number | 1861086019
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Entity Type | Individual
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Provider Name | JAZMINE FERGUSON
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Gender | Female
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 876 BEAVER CT
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City | FREMONT
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State | CA
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Zip | 94539-6036
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Country | US
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Telephone | 510-358-0448
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 S AMPHLETT BLVD
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City | SAN MATEO
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State | CA
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Zip | 94402
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Country | US
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Telephone | 650-931-6300
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | CA
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