MEDICARE: JESSICA ANN POOLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9723	CA

General Provider Information

NPI Number	:	1184351454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN POOLE

Provider Business Mailing Address
First Line	:	19303 ANSEL
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0170
Country	:	US
Telephone Number	:	562-397-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 CAMPUS DR STE 240
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2269
Country	:	US
Telephone Number	:	562-397-1070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “ JESSICA ANN POOLE ” Practice Location

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