Healthcare Provider Details

I. General information

NPI: 1801262332
Provider Name (Legal Business Name): JENINE YAGER STONE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 04/30/2024
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W. CITRACADO PKWY SUITE 108
ESCONDIDO CA
92025
US

IV. Provider business mailing address

625 W. CITRACADO PKWY SUITE 108
ESCONDIDO CA
92025
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-1431
  • Fax: 760-743-6455
Mailing address:
  • Phone: 760-743-1431
  • Fax: 760-743-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95059156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP95002748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: