Provider Demographics
NPI:1699062844
Name:RAFFETTO-MARTINEZ, JESSICA ERINNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERINNE
Last Name:RAFFETTO-MARTINEZ
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 1:10314 MANN DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1141
Mailing Address - Country:US
Mailing Address - Phone:408-838-4910
Mailing Address - Fax:
Practice Address - Street 1:10314 MANN DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1141
Practice Address - Country:US
Practice Address - Phone:408-838-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health