Healthcare Provider Details

I. General information

NPI: 1053795914
Provider Name (Legal Business Name): JESSICA HEROLD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 10/01/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A14912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: