Healthcare Provider Details

I. General information

NPI: 1003691957
Provider Name (Legal Business Name): WANDA JEANETTE DEQUARDO DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD STE 300
HUNTINGTON BEACH CA
92647-7172
US

IV. Provider business mailing address

28176 COULTER
MISSION VIEJO CA
92692-4064
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-1122
  • Fax: 949-863-8581
Mailing address:
  • Phone: 949-201-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95129597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: