Healthcare Provider Details

I. General information

NPI: 1003691692
Provider Name (Legal Business Name): PRECISION HEALTH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD STE 140
FULLERTON CA
92835-3427
US

IV. Provider business mailing address

270 LAGUNA RD STE 220
FULLERTON CA
92835-2521
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-4239
  • Fax: 858-764-9788
Mailing address:
  • Phone: 714-272-3477
  • Fax: 877-842-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ROELANDS
Title or Position: PRESIDENT
Credential: MD
Phone: 714-272-3477