Jennifer Agis
Individual provider Active NPI Counselor · Fremont, CA
NPI 1730318643 · NPPES record last updated Jul 13, 2009
Key facts
- NPI
- 1730318643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 39275 Liberty St # D-12
Fremont, CA 94538-1519 - Phone
- (510) 742-3904
- Fax
- (510) 742-3912
- NPI assigned
- Jul 13, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
39275 Liberty St # D-12
Fremont, CA 94538-1519
Mailing address
39275 Liberty St # D-12
Fremont, CA 94538-1519
Phone (510) 742-3904
Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.