Healthcare Provider Details

I. General information

NPI: 1316857451
Provider Name (Legal Business Name): JENNIFER VALLEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N MAIN ST STE 127
CORONA CA
92878-1440
US

IV. Provider business mailing address

765 N MAIN ST STE 127
CORONA CA
92878-1440
US

V. Phone/Fax

Practice location:
  • Phone: 951-216-3549
  • Fax:
Mailing address:
  • Phone: 951-216-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: