Healthcare Provider Details

I. General information

NPI: 1629917489
Provider Name (Legal Business Name): JACKIE BESTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S MISSION RD
FALLBROOK CA
92028-2898
US

IV. Provider business mailing address

407 S MISSION RD
FALLBROOK CA
92028-2898
US

V. Phone/Fax

Practice location:
  • Phone: 760-695-9608
  • Fax: 760-451-9430
Mailing address:
  • Phone: 760-695-9608
  • Fax: 760-451-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP21592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: