Individual provider Active NPI

Anne Brizielle Dejesus

  • Marriage & Family Therapist
  • Pleasanton, CA
National Provider Identifier
1417240813
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
73008 Issued in CA
Practice address
4361 Railroad Ave
Pleasanton, CA 94566-6611
Phone
(925) 249-3162
NPI assigned
May 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Marriage & Family Therapist 106H00000X 73008 CA Primary

Addresses

Primary practice location

4361 Railroad Ave
Pleasanton, CA 94566-6611

Mailing address

4361 Railroad Ave
Pleasanton, CA 94566-6611
Phone (925) 249-3162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240701002647 CA Order and Referring Only - Marriage and Family Therapist 2365986312

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1417240813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4361 RAILROAD AVE",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945666611",
            "telephone_number": "925-249-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 RAILROAD AVE",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945666611",
            "telephone_number": "925-249-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJESUS",
        "first_name": "ANNE",
        "middle_name": "BRIZIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-18",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "73008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.