MEDICARE: JESSICA PELUSO

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	172V00000X	Community Health Worker
2	1041C0700X	Clinical Social Worker	ASW138000	CA

General Provider Information

NPI Number	:	1639938616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PELUSO

Provider Business Mailing Address
First Line	:	2950 MEADOW VISTA RD
Second Line	:
City	:	MEADOW VISTA
State	:	CA
Zip	:	95722-9486
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 HIGHLAND POINTE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5427
Country	:	US
Telephone Number	:	916-783-5207
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	05/26/2026

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Directions to “ JESSICA PELUSO ” Practice Location

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