Provider Demographics
NPI:1225456346
Name:OKUNNUGA, JASEN DAYO (PPS)
Entity type:Individual
Prefix:
First Name:JASEN
Middle Name:DAYO
Last Name:OKUNNUGA
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4590
Mailing Address - Country:US
Mailing Address - Phone:650-526-7535
Mailing Address - Fax:
Practice Address - Street 1:505 ESCUELA AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2006
Practice Address - Country:US
Practice Address - Phone:650-526-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220154358101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool