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NPI Code Detail

MEDICARE: GENESIS GALILEA JASSO

MEDICARE: GENESIS GALILEA JASSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric Technician43135CA

General Provider Information

NPI Number : 1306785563
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENESIS GALILEA JASSO
Provider Business Mailing Address
First Line : 1212 N CALIFORNIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1552
Country : US
Telephone Number : 209-468-0103
Fax Number :
Provider Business Practice Location Address
First Line : 1212 N CALIFORNIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1552
Country : US
Telephone Number : 209-468-0103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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Directions to “ GENESIS GALILEA JASSO ” Practice Location

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