Provider Demographics
NPI:1104632900
Name:PAEZ, JESSELL ITZELA (MSW, ASW)
Entity type:Individual
Prefix:
First Name:JESSELL
Middle Name:ITZELA
Last Name:PAEZ
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 BLUE OAKS BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7052
Mailing Address - Country:US
Mailing Address - Phone:877-412-8031
Mailing Address - Fax:
Practice Address - Street 1:1400 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1537
Practice Address - Country:US
Practice Address - Phone:310-898-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1257481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical