MEDICARE: MS. CHRISTINA MARIE JALLAD

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
1	1041C0700X	Clinical Social Worker	61729	CA

General Provider Information

NPI Number	:	1548484496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA MARIE JALLAD

Provider Business Mailing Address
First Line	:	824 VILLA TER
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-1283
Country	:	US
Telephone Number	:	408-439-8061
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 DAVIS ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-6923
Country	:	US
Telephone Number	:	510-542-1731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	02/14/2025

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