Healthcare Provider Details

I. General information

NPI: 1619815958
Provider Name (Legal Business Name): JEEIRENE ADVANCED NURSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 PIPPIN DR
FALLBROOK CA
92028-3485
US

IV. Provider business mailing address

362 PIPPIN DR
FALLBROOK CA
92028-3485
US

V. Phone/Fax

Practice location:
  • Phone: 442-637-2634
  • Fax: 760-557-7428
Mailing address:
  • Phone: 442-637-2634
  • Fax: 760-557-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JEE ESTAVILLA
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 442-637-2634