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NPI Code Detail

MEDICARE: JESSICA PERALES

MEDICARE: JESSICA PERALES
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
1390200000XStudent in an Organized Health Care Education/Training ProgramAPCC12778CA
2101YP2500XProfessional Counselor22179CA
3171M00000XCase Manager/Care Coordinator
4101YP2500XProfessional CounselorAPCC12778CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APCC12778OTHERCABOARD OF BEHAVIORAL SCIENCE

General Provider Information

NPI Number : 1316417017
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PERALES
Provider Business Mailing Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 925-495-9898
Fax Number :
Provider Business Practice Location Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 925-495-9898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 03/31/2026

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Directions to “ JESSICA PERALES ” Practice Location

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