Provider Demographics
NPI:1932894052
Name:FERNANDEZ, JESSELYN SOQUENA (MS, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:JESSELYN
Middle Name:SOQUENA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 N TUSTIN ST # 1015
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3902
Mailing Address - Country:US
Mailing Address - Phone:951-288-9388
Mailing Address - Fax:
Practice Address - Street 1:2009 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3322
Practice Address - Country:US
Practice Address - Phone:562-794-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137634106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist