Provider Demographics
NPI:1356081699
Name:BORBOA, JESSICA (AMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BORBOA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W. GLENOAKS BLVD.
Mailing Address - Street 2:UNIT E #138
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201
Mailing Address - Country:US
Mailing Address - Phone:818-554-5704
Mailing Address - Fax:
Practice Address - Street 1:39159 PASEO PADRE PKWY.
Practice Address - Street 2:SUITE # 121
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:818-554-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty