MEDICARE: WILLIAM KEITH JAKINI NP

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	163W00000X	Registered Nurse	95211300	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95033332	CA

General Provider Information

NPI Number	:	1811575095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KEITH JAKINI NP

Provider Business Mailing Address
First Line	:	2167 BOWDOIN ST
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5474
Country	:	US
Telephone Number	:	909-938-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 BOWDOIN ST
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5474
Country	:	US
Telephone Number	:	909-938-9541
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	04/20/2026

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