Provider Demographics
NPI:1861140329
Name:ABREGO, JESSICA NOHELY
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:NOHELY
Last Name:ABREGO
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 1:2876 ROUND DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-3041
Mailing Address - Country:US
Mailing Address - Phone:323-313-1214
Mailing Address - Fax:
Practice Address - Street 1:225 S LAKE AVE STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3009
Practice Address - Country:US
Practice Address - Phone:626-432-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician