Healthcare Provider Details

I. General information

NPI: 1679480412
Provider Name (Legal Business Name): MISS LINDSAY ANGELICA JUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N GRAPE ST
ESCONDIDO CA
92025-3079
US

IV. Provider business mailing address

10168 WATERFORD LN
RANCHO CUCAMONGA CA
91737-2306
US

V. Phone/Fax

Practice location:
  • Phone: 760-975-9939
  • Fax:
Mailing address:
  • Phone: 909-367-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95463313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: