Provider Demographics
NPI:1992186514
Name:MARTINS BLAQUERA, JESSICA (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARTINS BLAQUERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2832
Mailing Address - Country:US
Mailing Address - Phone:925-223-8047
Mailing Address - Fax:925-223-8048
Practice Address - Street 1:5776 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 340
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2832
Practice Address - Country:US
Practice Address - Phone:925-223-8047
Practice Address - Fax:925-223-8048
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program