Provider Demographics
NPI:1518272426
Name:CARBAJAL, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SAN TOMAS CT
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5051
Mailing Address - Country:US
Mailing Address - Phone:510-860-3317
Mailing Address - Fax:
Practice Address - Street 1:1422 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3903
Practice Address - Country:US
Practice Address - Phone:510-550-8770
Practice Address - Fax:510-893-1642
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker